KM Youth Fishing Team Volunteer
Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
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California
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Delaware
District of Columbia
Florida
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Hawaii
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Maine
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Ohio
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Oregon
Pennsylvania
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South Carolina
South Dakota
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Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Fishing Experience
*
Beginner
Experienced
Accomplished
Level of Volunteer Interest
Local Fishing Coach
Advanced Bass Coach
Assistant Coach
Classroom Instruction
Administrative Help
Media/Advertising
Fundraising
Other
Emergency Contact Name #1
*
First Name
Last 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 Name
Last 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.
*
Yes
No
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 acknowledge that a
criminal background check
will be done on my behalf through the MN Bureau of Criminal Apprehension at no cost to me
Signature
*
Name
*
Date
*
/
Month
/
Day
Year
Date
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