Jerry Esten’s
7 TH ANNUAL KAYAK FISHING DERBY
Sunday September 21st at KING HARBOR, Redondo Beach, Calif.

RELEASE OF LIABILITY

        As a participant in Jerry Esten’s 7th Annual Kayak Fishing Derby, I am well aware of the dangers involved in the activities, including but not limited to such risks as capsizing, drowning, illness and injury.  There is also the possibility of theft and loss or damage to personal property.

        I hereby release and hold harmless the organizers of the event, Jerry Esten or anyone else associated with the production of this event, from any and all liability, causes of action, claims, costs, attorneys fees or debts arising out of their negligence or otherwise.

        I assume responsibility for all such risks and hazards associated with this event.

        I have read this Waiver and Liability Release and am aware that it is a release from liability arising from negligence and that I am assuming all risks, known or unknown.

        I agree with the terms and conditions of this Waiver and Liability Release and am signing it of my own free will.

Signature: ____________________________________________  Date: ____________________
                          (Required)


________________________________________________________________________

ENTRY FORM
(Please Print Legibly)

Name_______________________________      Email Address___________________

Address______________________________________       Phone Number________________________

City/State/Zip________________________________________

Signature____________________________________________________
                       (Required)

ENTRY FEE… $50.00   Enclosed.  This fee INCLUDES a $2.00 Jackpot. The pot will be at least $100.00 guaranteed.  If we have more than 50 contestants the pot will be accordingly greater.  The entire pot goes to the grand prizewinner. (First place)

Please make check payable to Jerry Esten and return this entire form with your check to:  Jerry Esten, P.O. Box 1224, Reseda, CA  91337

Fee includes the “Official Event T-Shirt”

If the prizes are anything like in previous years, and we expect them to be, you may take home $20 to $25 in tackle, accessories and more.