Surf Shack presents the 2006 Zap Long Beach Island Skim Jam - June 24th & 25th
                                                Please fill out form completely and legibly
                             Note: Enter the division based on the age you will be on 12/31/06

_____Minis (8 & under)                        _____ Men (18-21)                        _____ Sr. Grandmasters (40 & up)

_____ Menhunes (9-11)                       _____ Sr. Mens (22-24)                _____ Girls (1-14)

_____ Boys (12-14)                             _____ Masters (25-29)                   _____ Women (15 & up)

_____ Juniors (15-17)                         _____ Grandmasters (30-39)         _____ Open ($10 additional charge)

_____ Professional


Team Affiliation/Sponsors: _______________________________________________________________________
Name: ______________________________ Home Phone: ___________________ Work Phone: _______________
Street: _______________________________ City: _____________________ State: _____ Zip: _______________
Age:____________ Date of Birth: ________________ Email Address: ____________________________________

Entry fee is $25 for amateurs and $75 for pros, plus there is a $10 Skim USA membership fee due when
you pay your entry fee to your 1st Skim USA contest of 2006. Amount Enclosed $_______________________

Hold Harmless Release: This release bars your rights to recover damages in the case of an accident injuring you. READ BEFORE SIGNING. In applying to
the Skim USA tournaments, I promise to inspect the contest site, and assure myself that the area is safe for skimming and further agree that I will not skim in
the contest unless I am satisfied that area and conditions are safe for skimming purposes. In exchange for Skim USA accepting my entry form, I voluntarily
agree to assume all risks incident to the sport of skimming. With full knowledge, comprehension, and understanding of these responsibilities, I voluntarily
accept and assume all risks involved in the spirit of competitive skimboarding. I will further read and comply with all Skim USA rules and regulations, and do
agree that, noting existing weather conditions related to use of the contest site by myself and others I give Skim USA permission to arrange to telecast, show,
or print and publish any/or all audio and/or pictures taken of me (movie, video, or still) in conjuction with said event. In consideration of your acceptance of
my entry, I intend to be legally bound, hereby for myself, my heirs, executors and administrators, hold harmless and release and forever discharge Skim USA,
the city/town of Ship Bottom and Barnegat Light, the county of Ocean, the State of New Jersey, the sponsor, Surf Shack Surf Shop, Freedom Surf and Day
Spa, Glaspro Inc., and Skim USA, their members, agents, and any officials connected with this competition, from all liabilities for injuries and damages
whatsoever, arising from my presence and/or participation in the above described event and do hereby grant the sponsors such releases as described herein. I
acknowledge that i have read and understand all of the above.

Contestant's Signature ___________________________________________________ Date ___/___/___

FOR CONTESTANTS UNDER 18 YEARS OF AGE. I HEREBY CERTIFY that I am the parent or guardian of the participant named above, and do hereby give
my permission without reservation and with full understanding and comprehension of the foregoing aggreement to hold the aforementioned organizations
and government entities harmless of any and all liabilities including any such injuries which are alleged to have occured as a result of negligent failure of
Skim USA Officials, Judges, and Directors to properly supervise contestants in the course of competition.

Signature of Parent/Guardian _____________________________________________ Date ___/___/___