Liability Release

EVENT NAME:

EVENT DATE:

EVENT DESCRIPTION:

LOCATION:

JUNIOR ANGLERS & HUNTERS OF AMERICA, INC. (a 501 (c) (3) ORGANIZATION

EVENT REGISTRATION FORM

ADULT’S NAME______________________________________________________________

CHILDREN’S NAME & AGE (youth) ____________________________________________

ADDRESS____________________________________________________________________

CITY_____________________________________STATE_________ZIP__________________

PHONE ____________________________ EMAIL __________________________________

RELEASE OF LIABILITY/PHOTO RELEASE

As a parent or guardian of above named child, I certify that said child has my permission to attend and participate in the above-mentioned activity, held on the above date, time and location. In signing this form, I hereby waive and release Texas Parks & Wildlife, Department (TPWD), Junior Anglers & Hunters of America (JrAHA), Houston ISD, Eastwood Academy and all other participants, the host, the landowner, sponsors, and all other officials or parties involved in the activity from all claims and/or damage incurred in connection with this activity.

I also hereby grant Texas Parks & Wildlife Department and Jr. Anglers & Hunters the unconditional right to use the name, voice, video and photographic likeness of myself or of the listed child in connection with any of their audio/visual productions, articles, Public Service Announcements or press releases, fundraising campaign but not as a personal endorsement identifying me or my child by name nor edited for purposes not described above in the event description.

There are no monetary payment or royalties paid for being a photographed guest or for future media releases.

____________________________________________________ DATE____________________

Participant (if 18 or older) or Parent or legal guardian