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2017 Catfish Derby Registration
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Catfish Derby Registration Form
The Scott County Sheriff’s Office is holding their 17th Annual Youth Catfish Tournament on Monday, August 7, 2017. This event is open to Scott County youth or children who attend school in Scott County. Participants will meet at 6:30 a.m. at the Scott County Fairgrounds, 7151 West 190th Street, Jordan. Award Ceremony at 1:40 p.m. To register, please complete this form. Contact the Scott County Sheriff's Office, at 952-496-8300 with any questions. Applications will be accepted beginning June 26th and will remain open until all spots are filled. Space is limited to 50 participants. Priority will be given to individuals who have not participated in this event in the past.
-- Select One --
Child must be between the ages of 12 and 16 on the date of the event.
-- Select One --
Shirts are ADULT sizes
Child fished last year?
Preference will be given to the children who have NOT participated in this event in the past. If your child fished in the past, they will be put on a wait list for this year.
Child's First Name
Child's Last Name
Child's Phone Number
Parent Phone Number
Parent Address (if different from Child's)
Parent Home Phone
Parent Mobile Phone
Parent Work Phone
Alternate to parent listed above
Alternate Emergency Phone Number
List any allergies, special requests/needs, etc. that your child may have that you feel is important to include.
Waiver of Liability
I, am the parent of the above-named child, a participant in the Youth Catfish Fishing Derby sponsored by the Scott County Sheriff’s Office, hereby acknowledge that I know that boating excursions carry the potential risk of personal injury. I know that there are natural and manmade conditions and risks, which in combination with the actions of my child or those of others, may cause my child illness and/or severe or fatal injury. I agree that as a parent of a participant I and my child accept these risks, conditions, and hazards. I also agree the organizers or other participants in this event are not responsible for my child’s safety while she or he participates in this event and for the costs resulting from any injury my child may suffer from this event. I hereby release the organizers, volunteers, sponsors, and any persons or entities connected with this event from all liability for any injuries or damages incurred as a result of my child’s participation in this event. This release extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. I understand that by signing this waiver I am agreeing that I shall not bring any form of claim or legal proceeding against Scott County for any such injuries to my child. In connection with this event, photographs will be taken throughout the day. I give permission for electronic or photographic images of my children to be used by the Scott County Sheriff’s Office in its print or electronic media. I understand these photographs, although they will not include last names, will be available for public view. I agree my children may participate without financial remuneration, and I understand that this releases photographs and Scott County from any future claims as well as any liability arising from the use of said photographs.
TERMS AND ACCEPTANCE and SIGNATURE: I the parent of the above-named child, warrant the truthfulness of the information provided in this registration form. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Waiver of Liability and Terms of Acceptance.
Parent's name who is agreeing to the above Waiver of Liability and Terms of Acceptance.
You will be notified by email once your application has been approved.
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