Parent/Guardian's Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Kid #1 *

Please list all participant's ages 6-14 below

First Name

Last Name

Kid #2 (if applicable)

First Name

Last Name

Kid #3 (if applicable)

First Name

Last Name

Kid #4 (if applicable)

to register additional kids, please complete a new form.

First Name

Last Name

Release of Liability *

I hereby give consent for my child(ren) listed above to participate in Rep Vella's 2025 Fishing Frenzy. While every precaution will be taken to safeguard my child(ren), I understand and agree to release the event organizers and all sponsoring agents from all responsibility in case of accident or illness while participating in this event. I also give permission for photographs and videos taken during the Fishing Frenzy event, which may include my child(ren) and myself, to be used in promotional materials, social media, and event documentation.

Accept