OFFICIAL ENTRY FORM (Please submit entry form for each person in the boat). The Derby runs Saturday, June 15, daylight until 2 pm. Must be in line by 2 PM for weigh in of your fish. Lunch and award ceremony follows.
Name Age (if under 18)
Address
Email
City State Zip Daytime
Phone____________ PSA Chapter Affiliation (if member)______________________
Mail checks by June 10, payable to Puget Sound Anglers of Renton, or use credit card online by 2 PM June 16.
Derby tickets cost $25 per person. Free tickets to anglers 16 years old or younger.
$__________Enclosed
Mail completed entry form to PUGET SOUND ANGLERS OF RENTON, 4069 Hillcrest Ave SW, Seattle, WA 98116. Derby tickets will be sent via email to the above email. Or register online using credit card by 2 PM June 14 at www.rentonpsa.clubexpress.com.
The undersigned Participant in the 2024 Lake Washington Trout Derby ("Participant") hereby agrees to waive and release, and hold harmless THE PUGET SOUND ANGLERS OF RENTON, a nonprofit corporation of the State of Washington, and its officers, directors, committee chairs and members, from any and all claims, actions, damages, and costs of any kind, including but not limited to liability for personal injury, property damage or wrongful death, arising from or associated with the Participant's activities in the 2024 LAKE WASHINGTON DERBY.
As part of this agreement, Participant agrees to assume the risk for any such liability arising from or associated with any claims, damages and costs arising from Participant's activities in the DERBY.
The Derby Committee anticipates that the Derby will be an enjoyable and fulfilling activity for all Participants and their families. However, due to the risks inherent in all water sports, these protections were deemed necessary in order for the Derby to proceed.
I have submitted the proper entry fee and have read and agree to the rules and regulations covering the Derby. I understand that entry fees are non-refundable. I agree that the Derby hosts have exclusive rights to take photographs of myself and to use or dispose of such material in any lawful manner.
If anyone in your boat is under 18, and you are not the parent or guardian, you must complete this Derby Entry Form for them and have it signed by the parent or guardian. Please mail to the Derby Chair or carry it with you on your boat during the Derby.
DATE____________SIGNED___________________________________________
DATE____________Parent or Guardian, if under 18_________________________