Volunteer Name *

First Name

Last Name

Phone *

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Emergency Contact *

First Name

Last Name

Emergency Contact Phone # *

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By signing-up as a volunteer, I am voluntarily participating in the Volunteer Activities and I agree to accept all risks of participation. While every precaution will be taken to safeguard myself and others involved,, it is understood that I release State Rep. Dave Vella and its sponsoring agents from all responsibility, in case of accident or illness. I hereby give permission to use photographs/video taken pertaining to the Fishing Derby Event.