Fishing Has No Boundaries Registration 2015 template

20th Annual Fishing Event
Activity Schedule
Saturday, May 16, 2015
Sunday, May 17, 2015
8:00 AM
(Continental Breakfast)
9:00 AM
10:00 AM
11:30 AM
12:00-1:00 PM
1:00 PM
2:00 PM
3:30 PM
4:00 PM
8:00 AM
Begin Registration
(Continental Breakfast)
8:30 AM
Let’s Go Fishing
10:00 AM
(Possible) Boat Rides
11:30 PM
Return to Dock
12:00-1:00 PM
Lunch
1:00 PM
Awards Presentation
Begin Registration
Let’s Go Fishing
(Possible) Boat Rides
Return to Dock
Lunch
Cast Off Again
(Possible) Boat Rides
Return to Dock
Awards Presentation
Fishing Has No Boundaries Policies:
1. A responsible companion or attendant must accompany each participant. In some cases a group home supervisor
may supervise multiple participants. All participants under 18 must be accompanied by a parent, guardian, or
someone with authority who can make health related decisions in case of emergency.
2. Participants must register in advance (no same day registration) With your payment, you are registered.
No confirmation call will be made unless maximum capacity is reached.
3. Attendants --- Participants who will require medications, special diet or other special needs during the event are
responsible for these. Attendants are required to have information regarding participant’s medications with them
at the event in case of an emergency.
4. Regardless of one’s disability, there will be no independent fishing for this event. Participants must have
someone in attendance when fishing.
5. This is a catch and release event. All fish must be released immediately after measurement / photographs.
6. PLEASE NOTE: If a participant and companion would like to fish on shore and take a boat ride,
instead of fishing on a boat for an entire session, that may be an option ( depending upon boat availability )
Reminders:
1. Make checks payable to F.H.N.B. and send with Participant Registration Form.
2. All food, snacks, and soft drinks for both attendant and participant are included in the $10.00 fee.
3. Rods, reels, tackle, and bait will be provided or you may bring your own.
4. Bring sun-block , sun protection, and/or cool weather clothing.
5. Be prepared for all weather conditions – we fish rain or shine. (NO RAIN DATE)
6. All participants will receive a hat and tee shirt to take home.
7. Day of Event Phone Number at Cowan Lake: (513) - 379 - 7357
8. IF SHORE FISHING, PLEASE BRING LAWN CHAIRS OR A BLANKET TO SIT ON .
9. THE COMFORT ZONE – A private tented area for personal needs will be available
Additional Information:
(Follow us on FACEBOOK)
Fishing Has No Boundaries – Greater Cincinnati Chapter
Jane Brocker is in charge of registration. For questions and concerns, call: (513) 478 - 1418
Bill Reichert, Event Chair (513) 671 - 3343 (OR) view our website at www.fhnbcinti.com
**** PARTICIPANT REGISTRATION --- Cowan Lake State Park: May 16 – 17, 2015 ****
( REQUESTED MINIMUM AGE TO REGISTER 8 YEARS OLD )
NAME_____________________________________________________________________
AGE_______
ADDRESS____________________________________________________ CITY ____________________________
STATE:______________ ZIP:_____________
PHONE: (
) ____________________________________
EMERGENCY CONTACT (Name/Phone) __________________________________________________________
NAME: (Group Home/Affiliated Organization)______________________________________City_____________
ARE YOU A VETERAN OF MILITARY SERVICE ? Check
(please
circle)
Box>
Yes NO
WHEELCHAIR?
YES_____ NO______
or
No YES
(Only Manual Wheelchairs Permitted on Boats)
NAME OF ATTENDANT FOR PARTICIPANT:_____________________________________________________
(Participants MUST have Attendant or Companion familiar with the Participant’s needs)
ADDRESS & PHONE OF ATTENDANT:_____________________________________________________________
__________________________________________________(PH)_______________________
MEDICAL OR SPECIAL NEEDS:_________________________________________________________________
a.) Attendant required to have knowledge of participant’s medications for emergency
b.) If you have dietary restrictions, please plan to bring your own food
Check Box
Check Box
PREFER TO FISH:
PREFER TO FISH FROM :
______
SAT (5/16)
_____ BOAT FISHING (Availability Permitting)
______
SUN (5/17)
_____ SHORE FISHING ONLY
______
BOTH DAYS (Availability Permitting)
_____ SHORE AND A BOAT RIDE (Availability Permitting)
ENTRY FEE: $ 10.00 / Participant (No fee for Attendant)
Please make checks payable to: F. H. N. B.
NO CONFIRMATION CALL WILL BE MADE ( UNLESS MAXIMUM CAPACITY IS REACHED )
MAIL REGISTRATION AND ENTRY FEE TO :
( No Rain Date )
F.H.N.B. (c/o Jane Brocker)
61 Lakeridge Drive
Franklin, OH 45005
DEADLINE is APRIL 30, 2015.
Applications received after April 30 2015 will be placed on a waiting list in the
order received and only accepted if space is available. REGISTRATION WILL BE CUT-OFF ONCE OUR MAXIMUM
CAPACITY FOR A DAY IS REACHED. This could happen prior to the deadline date -----If capacity occurs, we will call
you. SO REGISTER EARLY. Each participant must register in advance. No refunds due to cancellations after May 1, 2015
RELEASE OF CLAIMS:
In acceptance of my participation in the FHNB Fishing Event on May 16 - 17, 2015, I release FHNB, Inc. and the FHNB Greater
Cincinnati Chapter, the Cities of Cincinnati and Wilmington, Counties of Clinton and Hamilton, Cowan Lake State Park, all
respective agents and employees and all others connected with the Event, from liability or claims for any injury to body or property or
illness sustained during my participation in this Event. I understand that this release applies to me, heirs, and anyone in participation
with me. I am capable of participating in this Fishing Event for Individuals with Disabilities, recognize that risk of injury may
accompany such participation, and acknowledge this release is being relied upon by this FHNB Chapter and FHNB, Inc. in permitting
me to participate. I grant full permission to any and all related during the Event to use any photographs, movies, recordings, and other
records of this Event without compensation.
If I do not follow all the rules of this Event, I understand that I may be removed from the Event.
______________________________________________________________________________
Signature of Event Participant
or
Legal Guardian
__________________________
Date