Fillable Sedge Island Sampler Registration Form

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Sedge Island Sampler Registration Form

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File type: PDF

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RegistrationForm
SedgeIslandSamplerforO.W.N.J.–August3,2019
RegistrationDeadlineJuly22,2019
Onlyoneregistrantperform.Pleaseuseanewformforadditionalregistrants.
Registrationsaretakenonafirst‐come,first‐servedbasis.
Name:_____________________________________________________________Age:________________
MailingAddress:____________________________________________________________________________
Email:____________________________________________________________________________________
CellPhone:________________________________HomePhone:_______________________________

Doyoucurrentlypossessanyofthefollowinglicenses? FishingHunting Both
WorkshopSessions:Foreachsession,chooseyourfirst,secondandthirdcourseoptions,with#1beingyour
firstchoice,#2beingyoursecondchoice,and#3beingyourthirdchoiceforeachsession.Youwillonlytake1
coursepersessiononafirst‐come,first‐servedbasisandcoursescannotberepeated.
SESSIONI SESSIONII
__________ BayFishing __________ BayFishing
__________ BayFishingBasics __________ BayFishingBasics
__________ Crabbing&Clamming __________ Crabbing&Clamming
__________ Kayaking __________ Kayaking
Noteanydietaryrestrictions:__________________________________________________________________
EmergencyInformation:
Whoshouldwenotifyintheeventofanemergency?______________________________________________
Phone#ofemergencycontact:________________________________________________________________
Listanymedicalconditions,allergies,etc.thatweshouldbeawareoforthatmayaffectmedicaltreatment:
__________________________________________________________________________________________
PhotoRelease:IgiveNJDivisionofFishandWildlifepermissiontousephotographsofmyselfforpromotionaland/or
educationalpurposesinprintedmaterials,suchasbrochures,orontheNJDivisionofFishandWildlife’swebsiteor
socialmediawiththeunderstandingthatnopersonalinformationwillbeshared.
YES NO
Waiver:
IunderstandthatallpossibleprecautionsaretakentoensurethatprogramsandactivitiesattheSedgeIslandNatural
ResourceEducationCenterareconductedbymatureandqualifiedpersonnelinasafeandresponsiblemanner.However,Ifurther
understandandagreethatSedgeIslandNaturalResourceEducationCenteranditsstaffcannotbeheldliableforanyaccident,
illness,ordiseasethatmightoccur.IalsoagreetofollowallrulesaccordingSedgeIslandpolicyandwithintheparkregulations.
Signature: Date:
ReturncompletedformbyJuly22and$20.00checkormoneyordermadeouttoNJOA‐EPto:
KarenByrne,NJDEPDivisionofFish&Wildlife,POBox418,PortRepublic,NJ08241
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Sedge Island Sampler Registration Form

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Completed 13 May 2021

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