Junior Anglers - Boater Registration

assignees, and

The event will take place on April 26th at Lake Ft. Phantom, located at 10818 FM 600, Abilene, TX. Registration will begin at 8:00 AM, with fishing starting at 9:00 AM. Lunch and an awards ceremony will follow.
Thank you for your consideration in volunteering as a boater this year! Please fill out the following form.

If you have a friend or family member who will be volunteering on the boat with you, please have them fill out a separate volunteer registration form.
westtexasrehab.org/ja-volunteer/

Name

First

Last

Email

Phone

Would you like to receive text updates about the event?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Age (Must be 18+)

T-shirt size?

Type of Boat?

Boat Capacity (excluding boater and any family member/helper in boat)

Do you attest your boat is in good working condition?

I have liability insurance on my boat. Liability insurance is required to participate as a boat volunteer. Please upload a copy of your liability insurance.

Click or drag a file to this area to upload.

Informed Consent and Acknowledgement and Media Release

You must check yes to participate in this event.

I hereby grant to West Texas Rehabilitation Center, their agents, successors, assignees, and affiliates, and their respective employees, officers, directors, board members, and representatives (collectively “Producers”) the right and permission to film, photograph, and record me, transcribe the recording, and to use my name, voice, image, information about me and any ideas or materials that I provide Producers (collectively, the “Materials”) in works created by Producers (the “Program”) and in connection with advertising, publicizing, broadcasting, producing, and exploiting the Program, in any and all media and mediums now known hereafter developed, in perpetuity. I understand that Producers are under no obligation to incorporate my appearance in the Program. Producer may edit and Video as it sees fit, and may resnlate the Material into languages other than English.

Signature

Clear Signature

Junior Anglers – Boater Registration

Informed Consent and Acknowledgement and Media Release