2010 Sponsor a Kid Fishing Tournament Entry Form
Saturday, May 15th - Rain date of Sunday, May 16th.

In consideration of being permitted to participate in the 11th Annual Sponsor a Kid Fishing Tournament,
I hereby release and discharge, Certified Marine Service, Inc., A & P Custom Tackle, their officers, employees
and sponsors from any and all claims, demands or causes of action arising out of or resulting from any
anticipated or unanticipated incident resulting from participation in the tournament. I hereby state that I
have read and understand all of these rules and regulations.

Sponsored Kid: _____________________________________________________Age:___________

Parent or Guardian: _________________________________________________________________

Address: _________________________________________________________________________

City: _________________________________State: ________________Zip: ____________________

Home Phone: ________________________Work: _________________Cell: _____________________

E-mail address:_____________________________________________________________________

Fishing from Boat (Y/N): ______Boat Name: _______________________Fishing from Shore (Y/N): ____

Signature of Kid:____________________________________________________________________

Signature of Parent or Guardian: ________________________________________Date: ____________

Would like to become a sponsor or donate to the tournament,
Call us or stop by for information on Kids Tournament.

Mail check or charge card information & form to:

Certified Marine Service, Inc.
PO Box 237, 166 First Street
Connelly, NY 12417

845-339-3060 Phone or 845-339-6183 Fax