ALL PASSENGERS MUST READ AND COMPLETE THIS FORM
Please complete the following form and submit at least 2 weeks prior to your trip.

PASSENGER INFORMATION & VOLUNTARY WAIVER
Please read carefully and fill in all of the information at the end

I hereby affirm that I am a licensed fisherman/fisherwoman, under the control and supervision of a certified USCG Captain, and that I thoroughly understand the hazards of extreme fishing including those hazards occurring during boat travel to and from the fishing site. I understand that these hazards include, but are not limited to, drowning, motion sickness, slipping or falling while on board, being cut or struck by a boat while in the water, injuries occurring while getting on or off a boat, and other perils of the sea. By signing this release, I certify that I am fully aware of and expressly assume these and all other risks involved in making such an EXTREME FISHING trip, whether conducted as recreational fishing or part of a fishing class or workshop.

This trip is not recommended for pregnant women, the elderly, people with chronic back or neck problems or previous back or neck surgery or those with heart conditions. This is a hardy sometimes jarring ride, depending on the weather and ocean conditions.

I understand and agree that neither CAPTAIN KIMBERLY JOHNS, (AKA CAPT. KUJO) the crew or owner of the vessel, nor THE BLACK ROCKET, the vessel, nor Black Rocket Charters, Inc., nor its affiliate or subsidiary corporations, nor the owners, officers, employees, agents, or assigns of the above listed individuals and/or entities (hereinafter “Released Parties”) may be held liable or responsible in any way for any occurrence on this fishing trip which may result in personal injury, property damage, wrongful death or other damage to me or my family, heirs, or assigns that may occur as a result of my participation in this extreme fishing trip or as a result of the negligence of any party, including the Released Parties, whether passive or active.

I further state that I am of lawful age and legally competent to sign this liability release, or that I have obtained the written Consent of my parent or guardian. I, by this instrument, do hereby exempt and release all the above listed entities and/or individuals from all liability and responsibility for personal injury, property damage or wrongful death, however caused, including, but not limited to, product liability or the negligence of the released parties, whether passive or active.

I acknowledge that I have read the foregoing paragraphs, fully understand the potential dangers incidental to engaging in this boat trip and extreme fishing, am fully aware of the legal consequences of submitting this instrument, and that I understand and agree that this document is legally binding and will preclude me from recovering monetary damages from the above listed entities and/or individuals whether specifically named or not, for personal injury, property damage or wrongful death caused by product liability or the negligence of the released parties, whether passive or active.

Photographic Release: I hereby irrevocably consent to and authorize the use of reproduction by Black Rocket Charters, Inc. or anyone authorized by Black Rocket Charters, Inc. or any and all photographs which you have this day taken of me, negative or positive, for any purpose whatsoever, without compensation to me. All negatives and positives (including digital images), together with the prints shall constitute property of Black Rocket Charters, Inc., solely and completely.