Knoxville​ ​CUSD​ ​#202​ ​Bass​ ​Fishing

Parent/Guardian​ ​Permission​ ​for​ ​Student​ ​Participation​ ​in​ ​Bass​ ​Fishing

Student​ ​Name:​ ​__________________________________________________________

PART​ ​1:​ ​(To​ ​participate​ ​in​ ​Bass​ ​Fishing​ ​statements​ ​must​ ​be​ ​answered​ ​with​ ​“YES”).
I​ ​do​ ​hereby​ ​give​ ​my​ ​permission​ ​to​ ​any​ ​qualified​ ​Physician​ ​or​ ​Trainer​ ​to​ ​administer​ ​emergency
treatment​ ​to​ ​the​ ​above​ ​named​ ​athlete​ ​when​ ​the​ ​supervisor​ ​feels​ ​there​ ​is​ ​such​ ​a​ ​need​ ​for
emergency​ ​treatment.
□​ ​YES​ ​□​ ​NO
The​ ​above​ ​named​ ​student​ ​is​ ​covered​ ​by​ ​my​ ​family​ ​hospitalization​ ​and​ ​medical​ ​insurance.
□​ ​YES​ ​□​ ​NO

PART​ ​2:​ ​EMERGENCY​ ​INFORMATION

Name​ ​of​ ​Insurance​ ​Company:​ ​_______________________________________________

Emergency​ ​phone​ ​numbers​ ​to​ ​reach​ ​Parent/Guardian:

Option​ ​#1:​ ​Name​ ​____________________________​ ​Phone​ ​#:​ ​_____________________

Option​ ​#2:​ ​Name​ ​____________________________​ ​Phone​ ​#:​ ​_____________________

PART​ ​3:​ ​WAIVER

In​ ​consideration​ ​of​ ​your​ ​acceptance​ ​of​ ​this​ ​entry:​ ​I,​ ​intending​ ​to​ ​be​ ​legally​ ​bound​ ​hereby,​ ​for
myself,​ ​my​ ​heirs,​ ​executors,​ ​and​ ​administrators,​ ​waive​ ​and​ ​release​ ​Knoxville​ ​CUSD​ ​#202​ ​and
Knoxville​ ​High​ ​School,​ ​their​ ​agents,​ ​committees,​ ​and​ ​members​ ​from​ ​any​ ​or​ ​all​ ​claims​ ​on​ ​rights
to​ ​damage​ ​for​ ​injuries​ ​or​ ​losses​ ​suffered​ ​by​ ​me​ ​directly​ ​or​ ​indirectly​ ​in​ ​training,​ ​or​ ​traveling​ ​to,​ ​or
from,​ ​or​ ​competing​ ​in​ ​or​ ​attending​ ​any​ ​events​ ​concerning​ ​the​ ​Knoxville​ ​High​ ​School​ ​Bass
Fishing​ ​team.
Participant:​ ​Signature:​ ​________________________________________________________
Date:​ ​_____________________________________________________________________
Parent:​ ​Signature:​ ​___________________________________________________________
Date:​ ​_____________________________________________________________________
Bass​ ​Fishing​ ​Team​ ​Survey
Name:​ ​______________________________________________________________________
Grade:​ ​_________________________
1.​ ​Why​ ​do​ ​you​ ​want​ ​to​ ​be​ ​a​ ​member​ ​of​ ​the​ ​Bass​ ​Fishing​ ​Team?

2.​ ​Do​ ​you​ ​have:

a)​ ​ ​Fishing​ ​rod​ ​□​ ​YES​ ​□​ ​NO
b)​ ​ ​Tackle​ ​(lures)​ ​□​ ​YES​ ​□​ ​NO
c)​ ​ ​Fishing​ ​license​ ​□​ ​YES​ ​□​ ​NO

3.​ ​Have​ ​you​ ​ever​ ​fished​ ​in​ ​a​ ​tournament?​ ​□​ ​YES​ ​□​ ​NO

4.​ ​How​ ​often​ ​do​ ​you​ ​fish?

□​ ​2-3​ ​times​ ​a​ ​week
□​ ​weekends
□​ ​2-3​ ​times​ ​monthly

Transportation​ ​Permission​ ​Slip

I​ ​understand​ ​that​ ​during​ ​the​ ​course​ ​of​ ​the​ ​Bass​ ​Fishing​ ​season,​ ​my​ ​student​ ​will​ ​not​ ​be
transported​ ​by​ ​bus​ ​to​ ​practices​ ​or​ ​tournaments.​ ​I​ ​hereby​ ​grant​ ​permission​ ​for​ ​my
student​ ​to​ ​be​ ​transported​ ​by​ ​the​ ​Bass​ ​Team​ ​sponsor​ ​and/or​ ​his​ ​designee.
Student​ ​Name:​ ​____________________________________________
Parent/Guardian​ ​Name:​ ​_____________________________________
Parent/Guardian​ ​Signature:​ ​__________________________________
Date:​ ​__________________________