Entry Blank

Denver Pyle's Children's Charities
P.O. Box 941   Paris, Texas  75460

$50 Individual Entry Fee
$225 Per Four Man Team Entry Fee

Name _____________________________________

Address ___________________________________

City ________________  State ______  Zip _______

FOUR MAN TEAM NAME
(If Applicable)

__________________________________

I have read and understand the rules and waive and release all other contestants, the host, and tournament officials from all claims of personal injuries, accidents and/or damaged, lost, or stolen property incurred in connection with the tournament.

I hereby grant permission to the tournament sponsors, and their agents, the right to publicize, video tape, photograph and/or broadcast my name, character likeness or voice, and the fact that I was a participant and/or prize winner, and all other matters incidental thereto.

Signature __________________________

Date _____________

THE FOLLOWING TO BE FILLED OUT BY A PARENT OR GUARDIAN OF PERSON UNDER 16 ENTERING THE TOURNAMENT:

As parent or guardian of the above mentioned youth who is under 16 years of age, I hereby consent to his/her submitting to a polygraph test should he/she qualify for one of the prizes. I hereby grant permission to the tournament sponsors, and their agents, the right to publicize, video tape, photograph, and/or broadcast his/her name, character likeness or voice, and the fact that he/she was a participant and/or prize winner, and all other matters incidental thereto.

Signature ___________________________
(Parent or Guardian)

Date _____________