2022 Elks Fishing DerbyUncategorized / By Mark Kenney 2022 Fishing Derby Parent’s Information Name Name First First Last Last Cell Phone (Prefered) Land Line Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Children (Max of 3) Child’s Name * Child's Name First First Last Last Age * Need’s a Rod & Reel * Yes No (Will bring their own) Add Remove Fishing Derby participants, parents, guardians, and other attending family members hereby agree to hold harmless the Elks Lodge #1622, any supporting organization and individual(s), the pond property owner(s). As such, the named parties conducting the event will not be considered responsible for any accidents or injuries that might occur. As representative for the participant and others, I hereby agree to this waiver of responsibility agreement. Authorized Agreement * I agree to the above statement Signature Clear If you are human, leave this field blank. Submit Share this:FacebookTwitterRedditPrint
