APPLICATION FORM EVENT LIMITED TO 100 KIDS - all applications will be processed in order of being received. Name of Child Boy Girl   Age of Child (Must be 10-15 years old) Number of times fished during a year? Parent's Name Phone Number at Home Phone Number at Work Mailing Address City State Zip Code E-mail Is your child on any medication, or have any special needs that we NEED to be aware of? If yes, what are they? Has Participant: His/her own fishing rod/reel? Yes No Fished before? Yes No Ever caught a fish? Yes No Fished in this event Yes No I understand my child will be wearing a PFD during the entire fishing time: Yes No Liability/Photo Release: As the parent or legal guardian of this applicant, I certify that said child has permission to attend and participate in the "Let's Take a Kid Fishing" event to be held on Wednesday, July 18, 2012 from 12PM (noon) - 5PM at Frazer Bay Landing. I have read the rules set forth for my child and agree by them. By signing this form, I hereby waive and release the event committee, participants, hosts, sponsors and all other officials or parties involved in the event from any and all claims and/or damages incurred in connection with this event. I also hereby grant the unconditional right to use the name, voice and photographs of my child in connection with any of the articles, press releases, official event website, event facebook page, guide websites, and audio/video productions. Yes No Now that you've filled out this submission, complete the Captcha challenge below and click the Submit button! (esad - spammers!)