Boat captain registration form

boat captain registration

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Shirt size *

Email *

Phone Number *

Assistant name *

Assistant Shirt Size *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Is your boat able to handle a wheelchair? *

No Yes, a manual wheelchair Yes, a motorized wheelchair

Entry or release of all claim: In consideration of the acceptance of my entry in the “Fishing has no boundaries” fishing event, I release FHNB, the City of Fond du Lac, Found du Lac County, sponsors, all respective agents and employers of the aforementioned and all volunteers who are connected with this event from any liability or claims for any injury to body or property or illness that I sustain during my participation in this event. I understand that this release applies to me, my personal attendant, heirs and assigns. I represent that I am capable of participation and acknowledge that this release is being relied upon by the above persons in permitting me to participate. I also grant full permission to any or all foregoing to use any photographs, videotapes, motion pictures, recordings or any other records of this event for any legitimate purposes. *

Checking this box below will serve as your electronic signature. Clicking this box means you have filled out this form to the best off your ability and have read and agree to the disclaimer. *

Yes, I, the boat captain. agree to the above and understand checking this box constituents my electronic signature. Yes, I, the assistant boat captain, agree to the above and understand checking this box constituents my electronic signature.

Submit