8-12 yr. old Fishing Derby

Something Else from Jill Montgomery

ANNUAL PUBLIC SAFETY YOUTH FISHING DERBY
ENTRY/WAIVER FORM
Name of Youth to be entered: ______________________________
(please print)
Age of youth being entered: _______________ (Must be 8, 9, 10, 11 or 12 ***)
I ___________________________________________, do hereby attest that I am the
(printed name of parent/guardian)
parent or legal adult guardian of the above named youth. I give permission for this youth to participate in the
Annual Public Safety Youth Fishing Derby on June 12, 2008.
I will insure that the above youth is accompanied by a responsible adult. I hereby release the City of
Muskegon, Muskegon Township and N. Muskegon and/or the Muskegon, Muskegon Township and N.
Muskegon Police and Fire Departments and personnel of any liability in reference to my child's attendance at
this event. I understand that this waiver must be one of the first 200 returned by June 6, 2008 in order for my
child to be eligible to attend. Note that this year the youth must use the bait that is provided so everyone has
an equal chance.
__________________________________ _____________________
Signature of Parent/Legal Guardian Date
Address: _________________________ Phone # _____________
(note: only the first 200 forms received will be entered - signature on this form indicates that
you have read, understand and agree to the contents of the flyer and entry/waiver forms)
You must check one of the following:
__________ This youth did not participate in a previous derby and does not have his/her
own fishing equipment and wishes to use the free equipment.
_________ This youth has participated in a previous derby or already has his/her
own equipment and will bring it to the derby.
**(Remember that we will be verifying participation in previous derbys)
MUST BE RETURNED NO LATER THAN JUNE 6 TO BE ELIGIBLE TO ENTER.
**********
Bring this sheet to the Muskegon or Muskegon Township Police Department
**DO NOT MAIL **

Regards, Live Dangerously Be A Conservative