Kerr Lake Sign-up - New Jersey B.A.S.S. Nation

Kerr Lake

Tournament Date: Wednesday, April 21st, 2024 through Friday, August 23rd, 2024

Tournament Location: 1000 Islands

Facility: French Creek

2024 1000 Islands IQT Sign-up

First Name(Required)

Last Name(Required)

Address(Required)

Street Address City State ZIP Code

Email(Required)

Phone(Required)

NJBN B.A.S.S. Club Name(Required)

Applicant's B.A.S.S. Number(Required)

Expiration Date(Required)

Category(Required)

Make of Boat(Required)

Length(Required)

State Boat Registration Number(Required)

Policy Number(Required)

Insurance Company(Required)

** Proof of $300,000 Boater’s Liability Insurance MUST be on file with the N.J. B.A.S.S. Nation Tournament Director before entry into any N.J.B.N. Tournament (See Rule A#2 of the official Tournament Rules)

GENERAL RELEASE, WAIVER AND HOLD HARMLESS AGREEMENT: In signing this application, I hereby waive and release all other contestants, the Host, Sponsors, NJ B.A.S.S Nation tournament officials and Board of Directors from all claims of harm, injury, damage of property and death that may occur by participating in this tournament. I also have read and fully understand all the rules of the “Official NJBN Tournament Rules”. I also understand that acceptance of this application is subject to the decision of the Tournament Director and the Board of Directors of the NJBN. By signing this application, I am stating that all information given is true. Any false information can result in disqualification and forfeit of monies or any other right given by entering this tournament. The NJBN agrees to keep all information confidential, except in a case of any rules infractions or false claims.

Signature(Required)

2024 Liability Waiver RELEASE OF LIABILITY — READ BEFORE SIGNING In consideration of being allowed to participate in any way in the NJ B.A.S.S. Nation program, its related events and activities, I, (Print Name) , the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE B.A.S.S. Nation and Its Member Clubs; B.A.S.S., LLC and B.A.S.S. Events, LLC, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my child and our heirs, assigns, 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 involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

Name(Required)

First Last

Age(Required)

Signature(Required)

Boater

Price:

$250 + $7.50 (convenience fee)

Rider

Price:

$125 + $3.75 (convenience fee)

Payment Method

Must choose one.

Credit Card(Required)

Cardholder Name

Card Details