Quiksilver King Of The Groms Skins Event Entry Form

Below is the official entry form for the Quiksilver King Of The Groms Skins Event that hits Sebastian Inlet June 6th to 11th. Copy the text, put it in a Word doc, print it out, and get it in. Or register online at Quiksilver.com/KOG. Be sure to sign up, because it’s free!

Quiksilver King Of The Groms Skins Event
Sebastian Inlet Waiting period June 6th to June 11th
OFFICIAL ENTRY FORM
•    Quiksilver Skins Entry is Free!!!
•    Must be born in 1993 or after (94’, 95’, 96’…. etc) and provide proof of D.O.B. with a photocopy of your birth certificate, passport, state I.D. and Social Security # to receive prize money!
•    Register online at Quiksilver.com/KOG
•    Fax your Entry and proof of D.O.B. to:  321 259- 9554

Name (Full)                    D.O.B.     /    /    Age:

Address

City                            State        Zip

Home ph                E-mail

Social Security #         -        -
In case of an emergency contact:
Relationship                            ph. #
Taking medication? Yes No     Allergic to any medications? Yes   no
What meds?

I understand that surfing is hazardous and I have made a voluntary choice to participate in this event despite the inherent risks.  I accept for myself any risks associated with the event and promise not to sue Quiksilver, Inc. or any of its affiliates for any and all losses and injury to person or property arising from or related to the event.

In consideration of accepting this registration, I hereby agree to release and hold harmless Quiksilver, Inc. and its affiliates, and any of their agents, officers, directors or employees from any and all liability or claims or actions for damages resulting from or in any way arising out of the participation in the event by the person registered, including claims based on Quiksilver, Inc.’s negligence or misconduct.  In the event of any dispute arising in connection with the competitor’s participation in the event, all such disputes shall be governed by California law and must be brought in the state or federal courts located in Orange County, California; the competitor hereby submits to such jurisdiction.

The competitor also grants Quiksilver, Inc. and its affiliates the right to photograph and video the competitor without any further compensation due to the competitor. Quiksilver Inc. and its affiliates also has the right to use, reproduce, distribute, sell and otherwise exploit such photographs and video of the competitor for commercial purposes, including posters, trading cards, advertising, and other promotional idioms in perpetuity without further compensation to the competitor.

I acknowledge that Quiksilver, Inc. or any of its affiliates may compile and use my name, likeness, recorded voice, addresses, photographs, biographical sketch, film and videos in advertising, marketing, product, packaging or other use, without compensation and without restriction as to duration, geography, media or frequency.  I consent to such uses and hereby waive all rights to compensation.

Signature:                            Date:

If minor under the age of 18, parent or guardian must sign below:
I, the undersigned parent or legal guardian of the minor competitor hereby acknowledge that I have carefully reviewed and understand the terms set forth above, and on my own behalf and on behalf of the competitor hereby consent to the above terms, covenants and conditions and agree to be bound by them to the fullest extent permitted by law.
Parent/Guardian Signature______________________Date  __________________________

Subject to availability. Limited number of entrants.