Form Center

2. BOATER INFORMATION
4. Full Name*
5. Cell Phone Number*
6. Age If Under 18
8. Address*
10. Email Address*
12. Emergency Contact Name*
13. Emergency Contact Phone Number*
15. CO-ANGLER INFORMATION
17. Name
18. Cell Phone Number
19. Age If Under 18
21. Address
23. Email Address
25. Emergency Contact Name
26. Emergency Contact Phone Number
28. BOAT INFORMATION
30. Boat Make & Model*
31. Boat Color*
33. WAIVER OF LIABILITY

    In consideration for being allowed to participate in the Law Enforcement Torch Run (LETR) Bass Tournament and receiving benefits therefrom, I do hereby, for myself, my heirs and representatives release LETR Bass Tournaments, the City of Warner Robins Georgia, the Warner Robins Police Department and all public officials, agents, employees or servants of the City of Warner Robins, which shall be referred to collectively as "the City,” from any and all liability , claims, demands, actions and causes of action of any nature whatsoever which I may hereafter have on account of any and all injuries, losses and or damages to me, including death, or to my property which arises out of or are related to my participation in LETR Bass Tournaments or any event or incident occurring while I am participating in LETR Bass Tournaments.

    For the same consideration, I agree to forever hold LETR Bass Tournaments and the City harmless for any and all liability, claims, demands, actions or causes of action that may be asserted against LETR Bass Tournaments and the City for damages, losses, injuries, and expenses to include attorney fees resulting from any participation in the LETR Bass Tournament.

    I expressly agree that this release and indemnity is intended to be as broad and inclusive as permitted by the laws of the State of Georgia and that if any portion hereof is held invalid the balance shall continue in full force and effect.

    IF PARTICIPANT IS UNDER 18 YEARS OF AGE:

    I, As parent/guardian do hereby certify that I have legal responsibility for the participant and I agree and give my consent to his/her release as provided above of all the releasees, and, for myself, my heirs, assignees, and next of kin, I release and agree to indemnify and hold harmless the releasees from any and all liabilities incident to my minor child's, or ward's, involvement or participation in the LETR Bass Tournaments as provided above, even if arising from the negligence of the releasees, to the fullest extent permitted by law.

35. Electronic Signature Agreement

    By typing your name in the box below, you agree and acknowledge that 1) the document will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

37. Electronic Signature*
38. Date And Time*
    Date And Time

    Date And Time
42. Electronic Signature Of Parent/Guardian Of Child Under 18
43. Date And Time
    Date And Time

    Date And Time
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit Submit and Print

* indicates a required field