Coffeyville Recreation Commission

23rdAnnual Youth Fishing Derby

Sunday,April 26th2015

LeClere Park

Coffeyville, Kansas

FREE OF CHARGE!

The “Buddy Bobber” Derby is specifically designed for the angler with special needs: Buddy Bobbers can have someone assist them throughout the derby.

Prizes will be awarded in each age division.

Age Divisions: 4-5, 6-8, 9-11, 12-14 and Buddy Bobbers

Order of Events:

Registration: 1:00-1:30 PM

Official Fishing Time: 1:30-3:00 PM

Awards & Dinner: 3:30 PM

There will be FREE hot dogs, soda, and chips for dinner (while supplies last).

Derby Rules:

  1. All participants must be registered by a parent or guardian.
  2. Only 4-8 year olds and “Buddy Bobbers” can have assistance.
  3. Watercrafts/boats/rafts will not be permitted by Derby Participants.
  4. Fish are to be caught and reeled in by participant.
  5. Fish will be measured and recorded by an official and released.
  6. Artificial or live bait can be used.
  7. ONLY 1 ROD AND REEL PER FISHERMAN!

For more information, contacttheCoffeyville Recreation Commission at(620) 251-5910.

Visit our website at

Coffeyville Youth Fishing Derby

Ages 4-14

Coffeyville Recreation Commission and the City of Coffeyville are offering a junior fishing derby for the following age groups: 4-5, 6-8, 9-11, 12-14 and Buddy Bobbers. All participants are required to have a registration form completed by a parent or guardian before they are permitted to participate. No fee is charged for this program.

Sunday,April 26th2015

1:00 PM

LeClereParkLake

CRC/City of Coffeyville

Consent Form &

Medical Treatment Authorization

Name of Participant:______

Address:______

Home Phone:______

Cell Phone:______

Parents Work Phone:______

Current Age:______

TO WHOM IT MAY CONCERN:

In the event that the above named child is taken to an emergency room or medical care facility in my absence at anytime during the fishing tournament, any official of the CRC/City of Coffeyville youth fishing tournament has my consent to authorize treatment for my child by a doctor(s) and or medial personnel which my be deemed necessary.

I, the undersigned, do herby acknowledge that I have full knowledge of the risks involved and I herby agree to assume those risks for the above named child, and to hold the Coffeyville Recreation Commission and the City of Coffeyville, all of their officers employees and volunteers, and sponsors free from liability for any injury, harm, or complication of any kind.

Furthermore, I do understand that accident insurance is not provided by the CRC or the City OF Coffeyville and I herby agree to assume full responsibility for any and all medical expenses resulting from any accident or injuries suffered by the above named participant while participating in the fishing tournament.

Special Instructions: (any medical problems or needs that should be brought to the attention of the officials):

______

Signature:______

Relationship:______

Date:______