Fill and Sign the Client Medical Form

Youth Bass Fishing Club Liability Waiver & Release Student’s Name (print neatly)__________________________________________ Parent Name _______________________________________________________ Parent Contact Number_______________________________________________ I understand that my child will be subject to the same standards of conduct as they are when in school. I further understand that the school may not carry insurance relative to the program or for injuries to the student during the program, and I represent that the student has insurance either through the district's student insurance program or through my own insurance carrier. In addition, if any emergency medical procedures or treatment are required during the program, I consent to the taking, arranging for, or the procedures of treatment according to the discretion of the supervisor(s) of this program. I release and waive all claims against the South Carolina Department of Natural Resources (SCDNR), (Insert County Name Here) County School District One, its board of trustees, the individual members thereof, all employees, representatives, and all agents thereof, from and against any claim which I, any other parent or guardian, any sibling, student or other person may claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries' arising out of, during or in connection with my child's participation in the school-sponsored program or the rendering of medical procedures or treatment for any injuries sustained during the program. Having fully acquainted myself with the rules and guidelines, I and my parents or legal guardians, have completed this event waiver and release application and submit it for my participation into all TBF events. In signing this application, and by my/our presence as the event, I/we hereby agree to be bound and comply with all event rules and safety regulations. I/we expressly assume all risks associated with the events and I/we hereby release The Bass Federation, Inc. (TBF), FLW Outdoors, Operation Bass, Inc., their parent and affiliate companies, their licensees and affiliates, and all their respective officers, directors, agents, employees, and stockholders, the tournament hosts, sponsors and tournament officials from all claims of death, injury and/or property damage incurred in connection with any of their events that I attend. I hereby waive my rights of privacy or publicity with regard to the unconditional right to use my name, voice, photographic likeness, video and biographical information and fishing tips and instruction in connection with their parent or affiliate companies, and those acting under their permission, anywhere at any time, through any medium or media. I/we shall not be entitled to receive any royalties or other compensation in connection with such use. I/we further understand and agree that the officials reserve the right to reject my application for any reason. I am currently a member in good standing of my home state federation, an affiliated TBF member club and TBF. Student’s Signature ___________________________________________ As the parent and legal guardian of the above named angler, I fully understand an hereby agree to the Rules, Terms and Conditions and the Waiver and Release of Liability contained in the attached document. I give my permission for the above named angler to join a Youth Bass Fishing Club and compete in the associated events. Parent’s or Guardian’s Signature ________________________________ Date _______________________________________________________