Springfield Bass Anglers

2015
Release Agreement

I hereby agree to hold harmless Springfield Bass Anglers, its officers, any member, any sponsor,
or any party associated with the site designated as a launch site and check-in site, during any
event and that the previously mentioned person or people shall not be liable under any
circumstances for any injuries or damages to person or property, arising out of, resulting from or
in any way connected with my participation in any tournament whether caused by negligent act
or negligent omission of the previously mentioned person or people, or by any other reason or
cause whatsoever.
I hereby acknowledge that I as an owner/operator, of the boat being operated during the
tournaments I will be participate in, that I do have proof of liability insurance that will be in
effect throughout the entirety of the tournament schedule and furthermore agree to notify the
tournament officers if my policy is no longer on effect before participating in any scheduled or
non-scheduled tournament held in association with Springfield Bass Anglers.
This agreement shall take effect as an instrument under seal and be binding to my heirs,
executors, administrators, successors, assigns and myself.

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Participant (please print)

Parent or guardian (if minor)

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Street address

Street address

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City

City

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State

State

Zip Code

Zip Code

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Home Phone

Home Phone

Cell

Other

Cell

Other

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E-mail address

E-mail address

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Participant (signature)

Parent or guardian (signature)

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Date

Date

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Boat Insurance Policy Number

Boat Insurance Agent and Carrier

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Boat Manufacturer

Engine Manufacturer