Club Name: ____________________________________________________________

Club Number: __________________________________________________________

Boat Captain Name: _____________________________________________________

B.A.S.S. Member # (if applicable):__________________________________________

Address: _______________________________________________________________

City: __________________________________________________________________

State: ______ Zip: ______

Email: _________________________________________________________________

Day Phone: (____) _______________________

Night Phone: (____) _______________________

Do you have any physical impairment? Yes ______ No ______

If yes, explain: __________________________________________________________

Having acquainted myself and\or the above named Jr Angler with the rules ; I (we) have completed this application and submit it for our\their entry into the Tournament. In signing this application, and by his\her\my presence at the event, I (we) as the parent or legal guardian of the above named Jr Angler, as the Jr Angler or as a Boat Captain, hereby agree to be bound by and comply with all Tournament rules and regulations. I (we) expressly assume all risks associated with the Tournament and I (we) hereby release, hold harmless and forever discharge, The Tennessee Federation Nation (TFN), all State Chapters, the event host, all sponsors, volunteers and tournament officials (hereinafter — Releasees“) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, property damage, or personal injury, including death, that may be sustained by me, my minor child or any property belonging to me, whether caused by the negligence of any of the releasees or otherwise while participating in any event hosted by the releasees. I (we) hereby grant TFN the unconditional right to use my or the above named Jr. Angler‘s, or Boat Captain’s name, voice, photographic likeness and biographical information and fishing tips and instructions in connection with any TFN State Championship video/audio production and/or articles and press releases. I (we) shall not be entitled to receive any royalties or other compensation in connection with such use. I we further understand and agree that the Tournament Director reserves the right to reject this application for any reason. The above named Jr. Angler is currently a member in good standing of a TFN Chapter and the B.A.S.S. Federation Nation. I (we) agree to follow all safety requirements at all times and remove ourselves from the competition if I (we) witness any unsafe acts and report them to a tournament official immediately. I (we) hereby consent to and authorize tournament officials to apply/secure or authorize emergency medical treatment on our own behalf or on behalf of the Jr. Angler of Boat Captain listed above, in the case of injury or emergency. I (we) agree to assume full responsibility for payment of any and all fees incurred as a result of such medical treatment.

Boat Captain Release- As the Boat Captain, I have read and fully understand the attached release of liability, consent for medical treatment and assumption of risk agreement as well as all the tournament rules. I fully understand them, understand that I have given up substantial rights by signing them and agree to be bound by them. I sign it freely and voluntary and without any inducement. Furthermore as a Boat Captain, I give my full consent and assume all responsibility for the Jr. Angler(s) and\or Observer that will be with my care during the TFN Junior State Tournament. NOTE: A copy of the Boat Captain‘s Insurance Policy with Liability coverage of a minimum of $100K must be submitted with this form.

Signed Boat Guardian: _____________________________________ Date: ____/____/_______

Emergency Contact Name: ____________________________________________________ Relationship: _______________________

Address: ___________________________________ Day Phone: (____) __________________

City: ______________________________________ Night Phone: (____) _________________

State: ______ Zip: ______