Kids Fishing Derby Online Registration

Child's Name *

First

Last

Age of Child (as of July 14, 2023) *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name of Parent or Guardian *

First

Last

Phone *

Email *

Release of Liability---By checking the boxes below you, parent or guardian, agree to the following: *

As parent/guardian of the above-named child, I hereby certify that I am the parent/guardian of said child and said child has my permission to attend and participate in the Davenport Pioneer Days Kids Fishing Derby.
I hereby waive, release, and hold harmless all other participants, hosts, sponsors, and all other officials or volunteers involved in the Kids Fishing Derby from all claims and/or damages incurred in connection with Davenport Pioneer Days Kids Fishing Derby.