2023 Bemidji Area Take A Kid Fishing

2023 Bemidji Area Take A Kid Fishing
Official Application-One Application Per Child

www.bemidjitkf.org

or

check us out on Facebook: Bemidji Area Take A Kid Fishing

Drop us a line to info@bemidjiTKF.org
Child's Name*
Gender*
Male / Female
Age (must be 10 15)*
Average # of Times Fished During a Year*
Parent's Name*
Parent's Phone: *
Email*
example@example.com
Address*

Address

Street Address Line 2

CityState

Zip
These questions are designed to help us adequately prepare to accomodate your child for a fun-filled day of fishing on the lake. Answers will NOT affect the child's eligibility to participate.
Does your child take any medication, or have any special needs?*
Does your child have any other commitments on this day?
Why does child wish to go fishing?
Does your child have a particular guide they would like to be placed with?
Has the Child:

Ever Fished BeforeCaught a FishEver Fished this EventOwn a Life JackdetOwn a Rain JacketOwn a Rod & Reel
Release of Liability/Photo Release: I certify that my child has permission to attend and participate in the Bemidji Area Take A Kid Fishing event, sponsored by the Take A Kid Fishing committee, to be held on June 7th 2023, starting mid-morning and concluding at 5:00pm at Lake Bemidji State Park with a fish fry. By signing this application form, I hereby waive and release; all other participants, the host, sponsors, and all other officials or parties involved in the event, from all claims and/or damage incurred in connection with this event. I also hereby grant the sponsors and cosponsors the unconditional right to use the name, voice, and photographic likeness of (child's name) in connection with any of the articles, press releases, and audio/video productions. Parent/Legal Guardian Signature:Date: Parent/Legal Guardian Printed Name:
Parent/Legal Guardian Signature*

Clear
Date*

MonthDayYear
Date
Parent/Legal Guardian Printed Name*
Must be Returned by June 1, 2023 to:

Dave Brinkmann Bemidji Area Take A Kid Fishing

Higgins Heating

1632 Bemidji Ave. N. Bemidji, MN 56601

OR

Email: info@bemidjiTKF.org

Bemidji Area Take A Kid Fishing Event June 7th 2023

Meet guides at 10:00a.m. @ Cameron Park & 5pm Fish Fry @ Bemidji State Park

Contact:

Christina Regas - TKF Committee Cell: (218) 368-9394

Jim Joy-Lead Guide Cell: (218) 556-0208

Demo Regas-Lead Guide Cell: (218) 407-0396
Should be Empty: