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PLEASE PRINT CLEARLY AND LEGIBLY. Name: Age: Birthdate: Captain Name: Captain Phone: Email Address: If fishing from a boat please enter required boat information. Boat Name State Registration # Boat Manufacturer Engine(s) Manufacturer Length Hull Color Trim Waiver: Please read carefully before signing. As the parent and/or Captain of the vessel of the above named participant(s), this is to acknowledge that I realize that my child is participating in the Junior Kingfish Challenge at his or her own risk. I confirm that we have read and fully understand the rules of the Tournament and this waiver and agree to abide by the rules and terms of this waiver. I agree that in consideration for the acceptance of this entry and of my child’s participation in the Junior Kingfish Challenge Tournament, for my child and myself, I hereby release and forever discharge Ancient City Game Fish Association, Inc. (ACGFA)d/b/a Kingfish Challenge Tournament, their sponsors, representatives, successors and assigns of all liabilities, claims, actions, damages, costs or expenses which I or my child may have against them arising out of or in any way connected with my child’s participation in this event. I understand that this waiver includes any claims based in negligence, action or inaction of any of the above-named parties. I hereby authorize the use of my child’s name and or likeness as well as that of all crew members, free of any consideration, for promotion and advertising purposes in any media form and reproduction, including, but not limited to radio, television, newspaper, brochure, video or internet. Enter Early! Tournament limited to 125 Junior Anglers Entry to the Junior Challenge allows the senior angler, junior angler or small-fry angler to fish in BOTH the Kingfish division or Redfish division. The top 3 entrants in each age division and fish division will be awarded prizes (18 prizes in total). Prizes are limited to 1 per angler and will automatically be sorted to the prize of greatest value. Only $25 Registration JUNIOR CHALLENGE ANCIENT CITY GAME FISH ASSOCIATION Two ways to register! Mail completed form and payment to: Kingfish Challenge P.O. Box 2001 St. Augustine, FL 32085 Register online at www.acgfa.com/ challenge-tournaments Tournament Hotline 904-669-5153 Entry Fees include STATE of FLORIDA SALES TAX. Disclaimer: Please read carefully before signing. The tournament committee, at its discretion, may ask the entrants to submit to a poly- graph examination if the entrants wish to be considered for prizes in the tournament. By signing the entry form, each entrant agrees that the tournament committee is to be the full and final arbitrator of rules and disputes which may arise. Further, entrant acknowledge the entry form is a binding contract between the tournament and the entrant, and that the decision of the tournament committee is final and is not reviewable by a court of law. $ Total Entry Fee ($25/angler) CASH OR MONEY ORDER AT REGISTRATION, CREDIT CARDS ACCEPTED - $5 PROCESSING FEE. Angler Parent or Legal Guardian Signature CREDIT CARD/SQUARE CASH CHECK DONATION______________ [ ] Small Fry [ ] Junior [ ] Senior [ ] Check the box at left if you do not want to receive offers from our valued sponsors and partners via email. By signing this form, entrant grants permission to use his or her image and all team members in video or photographs for social media, media, promotional, and marketing purposes.
