Kids Fishing Derby Online Registration

Please enable JavaScript in your browser to complete this form.

Child's Name

First

Last

Age of Child (as of July 19, 2024)

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.