Club Name: ___________________________ Club #: ________________________________

Jr. Angler Name: ______________                       ___ Date of Birth: ______ / ______ / _______

Junior Angler Member #: _______________________ Age Group: ______ 11-14 ______ 15-18

Address: ________________________________________ Sex: ______ Male ______ Female

City: _________________________________________________ State: ______ Zip: ______

Email: _______________________________________________________________ Day Phone: (____) _______________________

Do you have any physical impairment? Yes ______ No ______ Night Phone: (____) ___   ______

If yes, explain: _____________________             ____________________________________

Having acquainted myself and\or the above named Jr. Angler with the rules; I (we) have completed this ap 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 ee 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 in 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.

As the parent or legal guardian of the above named Jr. Angler, 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 attached. 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 voluntarily without any inducement. Further, as a parent or legal guardian, I give my full consent and assume all responsibility for the above named Jr. Angler to participate in the Tennessee Federation Nation Junior State Tournament. Note: A copy of the Jr. Angler’s birth certificate must be submitted with this form.

Signed Parent / Legal Guardian: _____________________________________________________ Date: ____/____/_______

Jr. Angler Release- As the Jr. Angler listed above, 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 attached. 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 voluntarily without any inducement. Further, I will pledge to conduct myself in such a manner as to promote good sportsmanship and conservation at all times.

Signed Jr. Angler: ________________________________________ Date: ____/____/_______

Emergency Contact Name: ____________________________________________________ Relationship: _______________________

Address: ______________________________ Day Phone: (____) __________________

City: __________________________________ Night Phone: (____) _________________

State: ______ Zip: ______