Boat Captain

KM Youth Fishing Team Boat Captain Registration Form

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

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

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.Format: (000) 000-0000.

Insurance Policy Number

Emergency Contact Name #1

First NameLast Name

Emergency Phone Contact #1

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact #1 Relationship to you

Emergency Contact Name #2

First NameLast Name

Emergency Phone Contact #2

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact #2 Relationship to you

Medical Information

Rows	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.

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