Adult Registration Please enable JavaScript in your browser to complete this form.NameAgeAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEventFishing SchoolGuided TripEmail Address *Release: (Type Name Below) *I, the undersigned, recognize the hazards of kayak fishing and hereby release Kayakjak's Outfitters and Guide Service, its principals, directors, officers, agents, employees, and volunteers, their insurers and each and every landowner, municipal and/or government agency upon whose property an activity is conducted ("owner") and their insurers, if any ("collectively releases") FROM ANY AND ALL LIABILITY OF ANY NATURE FOR ANY AND ALL INJURY OR DAMAGE (INCLUDING DEATH) TO ME OR MY MINOR CHILDREN AND OTHER PERSONS as a result of my/our participation in the activity. EVEN IF CAUSED BY THE NEGLIGENCE OF ANY OF THE RELEASES NAMED BELOW, OR ANY OTHER PERSON (INCLUDING MYSELF) Signature *Clear SignatureDate / Time *DateTimeMessageSubmit Adult Registration was last modified: January 9th, 2021 by Marty