Customer Information Form

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact - Name:*

Emergency Contact - Phone:*

Please enter a valid phone number.Format: (000) 000-0000.

Name

First NameLast Name

Name

First NameLast Name

NoYes

If Yes, please list height and weight of each child to allow us to choose the appropriate life vest. North Carolina law requires all passengers under the age of 13 to wear an approved life vest while the boat is underway.

NoYes

If Yes, Please Explain:

RELEASE OF LIABILITY AND A WAIVER OF CERTAIN LEGAL RIGHTS

Fishing and boating are potentially dangerous activities. Strike Charters, LLC, adheres to the highest safety and training standards but there are inherent risks which we can not control and can not be eliminated.

I, the undersigned, in consideration of the service of Strike Charters, LLC, its officers, employees, contractors, agents or representatives, hereby agree to release and hold harmless Strike Charters, LLC, on behalf of myself, my heirs, assigns, personal representative and estate as follows: I understand and acknowledge that the activity I am about to voluntarily engage in as a participant bears certain known risks and unanticipated risks which could result in injury, death, illness or disease, physical or mental damage, or damage to myself, to my property, or to spectators or other third parties. Risks include, but are not limited to: death, drowning, bodily injury, sunburn, dehydration, insect or animal bites, encounters with wildlife, and other harm which may be encountered in participating in wading, boating, guided and unguided fishing, and those activities associated therewith. I expressly agree to accept and assume all responsibilities and risk of injury, death, illness or disease, or damage to myself, to others, or to my property, arising from my participation in this activity. In signing this document, I fully recognize that if anyone is injured or property is damaged while I engage in this activity, I will have no right to make a claim or file a lawsuit against Strike Charters, LLC, or its officers, agents, contractors, or employees.

PHYSICAL HEALTH: To the best of my knowledge, I, the customer, have no physical restrictions which would prohibit my participation in activities offered by Strike Charters, LLC, including boarding or disembarking the vessel, fishing, boating, or consuming food or beverage prepared by the outfitter or their representatives. Should emergency medical services become necessary to me or any minor I have authorized to participate, I agree that I will not hold Strike Charters, LLC, liable regarding the provision of medical and/or emergency care or the adequacy of any such care. Strike Charters, LLC, reserves the right to decline service to any person it judges incapable of meeting the requirements of participating in fishing related activities.

Signature

Customer Information Form

Other Passenger Information