NewJerseyDivisionofFishandWildlife
Attn:LizJackson,HOFNODCoordinator
605PequestRoad
Oxford,NJ07863
Phone:9086374125x122
Fax:(908)6376735
Email:Liz.Jackson@dep.nj.gov
ThisprogramissponsoredbytheNewJerseyDivisionofFishandWildlife.
YouthRegistrationandPhotoReleaseAgreement
TeamName:___________________________________________________________________________
Mychild,________________________________________(printfirst&lastname),haspermissionto
participateinactivitiesrelatedtotheHOFNODProgram.Iunderstandthatthiswillincludeeventsonand
offsite.PleasenotethatoneoftheHOFNODactivitiesisaconfidentialsurvey,whichmeansthatnoonewill
everreporthowyourchildindividuallyansweredquestions.Thesurveywillaskyourchild’sopinionabout
theirneighborhoodandnatureaswellastheirperceptionsof,andengagementwith,alcoholanddrugs.
Parentvolunteersalwaysmaketheprogrammuchmorememorable.Ifyouwouldliketovolunteerforthe
programincludingfieldtrips,pleasewriteyourname,telephonenumberandthebesttimetoreachyou:
________________________________________________________________________________________
________________________________________________________________________________________
Whattypesofactivitiesareyouwilling/abletohelpwith?(Pleasecheckallthatapply)
EducationalActivities
FishingSkills(Handson)
Other:__________________________________________________________________
IgiveconsentthatallphotographsofmychildandIbeusedinlocalnewspapersandNew
JerseyDivisionofFishandWildlifepublic ations,includingprintedorelectronicinformation
aboutHookedonFishing—NotonDrugs.Inaddition,allphotographsofmychildandImay
beusedinlocal,state,andnat
ionalpublications.
YouthName(Printed):_____________________________________________________
ParentName(Printed):_____________________________________________________
ParentSignature:__________________________________Date:______/______/20____
Print Form