Fishing Has No BoundariesFond du Lac Chapter
Menu
Participant registration
Participant Registration is $60 per person ($70 after August 1). This includes all meals, fishing equipment, and liability insurance. Payment should be mailed to : FDL Fishing Has No Boundaries, PO Box 54, Fond du Lac, WI 54936. Please indicate participants name in the subject line on check. Thank you!
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Shirt size
*
Email
*
Phone Number
*
Are you fishing with us
*
Both Saturday and Sunday
Just Saturday
Just Sunday
Nature of disability
*
Are you in a wheelchair?
*
No
Yes, a manual wheelchair
Yes, a motorized wheelchair
Can you be taken out of the chair (check box if yes)?
If you have allergies, please list them here.
*
Please list medications.
*
Do you need a member of FHNB to administer your medication?
*
Yes
No
Do you need a personal assistant?
*
Yes
No
If you need a personal assistant, are you bringing your own?
*
Yes
No
If you're bringing your own assistant, what is his/her name?
*
In some cases, family members like to join the participant for meals. Each meal is $10. Please indicate below which meals will have additional guests.
*
Saturday, breakfast
Saturday, lunch
Saturday, dinner
Sunday, breakfast
Sunday, lunch
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 agree to the above and understand checking this box constituents my electronic signature.
Submit
Home
History
Summer Event
Participant registration form
Boat captain registration form
Winter Event
Support Us
Doris Ekstrom Scholarship
Contact Us
Walleye Weekend Family Fishing
Home
History
Summer Event
Participant registration form
Boat captain registration form
Winter Event
Support Us
Doris Ekstrom Scholarship
Contact Us
Walleye Weekend Family Fishing