If someone other than you will sign your child(ren) in or out, please list their name(s) below:
Please enter your Second Child's Information:
Informed Consent and Acknowledgement
I hereby give my approval for my child’s participation in any and all activities prepared by Cape Kids Fish Club. In exchange for the acceptance of said child’s candidacy by Cape Kids Fish Club, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Cape Kids Fish Club and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected Cape Kids Fish Club program activites.
In case of injury to said child, I hereby waive all claims against Cape Kids Fish Club, including all staff and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct activities. There is a risk of being injured that is inherent in all sports activities, including fishing. Some of these injuries may include, but are not limited to, puncture wounds from fishing hooks, head injury, paralysis, or death.
Medical Release and Authorization
As Parent and/or Guardian of the named child, I hereby give permission for Cape Kids Fish Club, including Cape Kids Fish Club Directors and Staff, to obtain medical treatment for my child by qualified personnel and, if circumstances warrant, to allow transportation of my child to a hospital.
I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named child. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.
Permission is also granted to Cape Kids Fish Club and its affiliates, including Directors, Staff, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.
Release authorized on the dates and/or duration of the registered program.
This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Our ages 8-10 fishing program dates are listed below. Please select your desired program(s):*