2025 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: Age (must be 10-15): Parent's Name: Work/Cell Phone:

Childs Name

Parents Name

Age must be 1015

Gender: Average # of Times Fished During a Year: Home Phone: Email

Gender

Average of Times Fished During a Year

Address

Email

example@example.com

City

State

Zip

Questionnaire: These questions are designed to help us adequately prepare to accommodate 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?: Yes Please Explain: Does your child have any other commitments on this day?: Why does child wish to go fishing?:

Please Explain

Does your child have any other commitments on this day

Does your child have a particular guide they would like to be placed with

Has the child: Ever Fished Before:

Caught a Fish: Ever Fished This Event:

Does the child: Own a Life Jacket:Yes Own a Rain Suit:Yes Own a Rod & Reel:Yes

Release of Liability/Photo Release: As a parent or legal guardian of 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 11th 2025, 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:

, I certify that said child has

ParentLegal Guardian Signature

ParentLegal Guardian Printed Name

Date

Must be Returned by June 6th, 2025 to:

Clip and Save for Your Information

Dave Brinkmann Bemidji Area Take A Kid Fishing Higgins Heating 1632 Bemidji Ave. N. Bemidji, MN 56601 Email: info@bemidjiTKF.org

Bemidji Area Take A Kid Fishing Event June 11th 2025 Meet guides at 10:00a.m. Cameron Park & 5pm Fish Fry @ Bemidji State Park Contact: Jim Joy-Lead GuideChristina Regas - TKF Committee Cell: (218) 556-0208 Demo Regas-Lead Guide Cell: (218) 407-0396