Oak Island Parks and Recreation Department
4601 E. Oak Island Drive
Oak Island, NC 28465
Phone: 910-278-5518/4747
Fax: 910-278-5350/4991
WAIT REGISTRATION FORM
Circle One:
Option One:
Day of instruction and day of fun and fishing at Pier – for $49.00
Option Two:
Day of instruction and backwater fishing trip on Sunday - $129.00
Do you have a friend who would like to fish with you: name______________________
I consider myself a: (circle one) Beginner Angler Advanced Angler
(Please Print*) Name: ______________________________________________________
Address: __________________________________________City____________________________________________
Phone # : ____________________________________________ Work #: ______________________________________
Emergency contact: _____________________________________________ Phone #: ____________________________
Medical information staff should be aware of: ____________________________________________________________
_________________________________________________________________________________________________
Authorization
I_______________________, hereby give approval for his/her participation in any and all activities during the duration of the program/league/sport. I assume all risks and hazards incidental to participation including transportation to and from activities; and hereby waive, release, absolve, indemnify and agree to hold harmless the Town of Oak Island, local league organization, the Oak Island Parks and Recreation Department, sponsors, supervisors, officials, participants and all other persons involved in various capacities with the above activity for any claims, demands, or courses of action arising out of or by reason of the above activity for which the participant is registered.
I also grant permission to managing personnel or other league representatives to authorize and obtain medical care from any licensed physician, hospital or medical clinic should the participant become ill or injured while participating in said activity or any associated and submit authorization for emergency treatment.
Signature:
_____________________________________________________________