Boat Captain

KM Youth Fishing Team Boat Captain Registration Form

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Date of Birth*

Date

Email*

Confirmation EmailConfirm Email Address

Jersey Size*

Last Name*

to be printed on jersey

Fishing Experience*

BeginnerExperiencedAccomplished

Boat Brand*

Boat Model*

Motor Brand*

Motor Horsepower*

Trolling Motor Brand*

Trolling Motor Horsepower*

Insurance Company Name*

Insurance Agent Name*

Insurance Agent Phone Number*

Please enter a valid phone number.

Insurance Policy Number*

Emergency Contact Name #1*

First NameLast Name

Emergency Phone Contact #1*

Please enter a valid phone number.

Emergency Contact #1 Relationship to you*

Emergency Contact Name #2*

First NameLast Name

Emergency Phone Contact #2*

Please enter a valid phone number.

Emergency Contact #2 Relationship to you*

Medical Information*

	None	Specify
Allergies
Medical Condition

I grant the Kasson Mantorville Youth Fishing Team the right to take photographs of me, my property and my minor child. I agree that they may use such photographs, with or without my name, for any lawful purpose including publicity, advertising, and web content.*

YesNo

By signing this form you acknowledge the following:

The Kasson Mantorville Youth Fishing Team is not responsible for any injuries that may occur and hereby assume any risks involved with participating in this activity. In the event I become ill or injured while participating in any team activity, I hereby give my consent to team officials or their designee, its members and/or officers to authorize the administration of any emergency medical treatment deemed necessary.

I have reviewed AND understand the chemical policy and handbook for the Kasson Mantorville Youth Fishing Team.

I have reviewed AND understand the Tournament rules as set forth by the league my anglers are fishing.

I agree to maintain watercraft liability insurance on my boat. I understand amounts vary depending on tournaments, but the minimum amount is typically $300,000 liability coverage.

My boat is at least 16’ in length and is equipment with running lights and a throttle kill switch that can be tethered to my life jacket.

I acknowledge that a criminal background check will be done on my behalf through the MN Bureau of Criminal Apprehension at no cost to me.

I acknowledge that I need to fill out liability waivers through the MN SATT website as well.

Signature*

Name*

Date*

Date