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Directions: Print this
page, complete all information, enclose payment, mail or bring to the Paddle
Shack. |
5045 Mays Landing Road
Mays Landing, N.J. 08330
609-909-5250
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"The
Best Little Paddle Shack in South Jersey" |
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The Great South Jersey Striped Bass
Kayak Fishing Registration Form All Participants Must Be Over 18 Years Old
Registration Deadline
The tournament runs from October 1st thru 31st; get out often and find that trophy Striper!
Participant's Info
Name:_______________________________________________________ Age:_______
DOB:________________
Paddling Experience:
type___________________________________________________/yrs_________________
Kayak Fishing
Experience:_______________________________________________________________________
Street
Address:________________________________________________________________________________
City: ________________________________________________________State: _______Zip:_________________
Telephone:(____)-____________________email:_____________________________________________________
Kayak
Make: _____________________Model:
___________________________________________tandem/single
Do you anticipate renting a fishing
kayak? Yes__ / No__
From?
_______________________________________
Do you plan to use barbless
hooks? Yes___ / No___
Active Duty Military Fee
Waiver
In recognition of your
service and hardships, and
as a minor way of saying
"thank you", all Active Duty
Military or National Guard
and immediate family members
of active duty military and
nation guard personnel
serving in or recently
returned from Iraq or
Afghanistan are invited to
participate in the
tournament without
registration expense or
Paddle Shack kayak rental expense.
Name of family member on
active
duty:_________________________________________________
Age:_______
Relationship: (husband/son,
etc)__________________________________________________________________
Branch of
service_________________________________________________________
Rank:________________
Deployed
to__________________________________________________________________________________
Overseas deployment time
frame_________________________________________________________________
Liability
Waiver, Assumption of Risks
As with any outdoor water
related activity, there is a
potential for serious injury
or death from various
sources, such as drowning,
hypothermia, shark attack,
accidental self inflicted
wounds from knives and
hooks, collision with other
vessels, weather, etc. For myself and my heirs, I assume all liability for my actions, assume responsibility for all risks, and relieve Paddle Shack, its staff, owners, sponsors and representatives from any liability for any consequence or action resulting from participation in any manner in this event. Participants Signature:________________________________________________________ Date:___________
Registration Fees
Kayak and single
paddler.....................................$20.00
Tandem Kayak w/two
participants
fishing............$40.00
Each participant must complete a registration form. Participants must be at
least 18 years of age.
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