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2022 Youth Fishing Derby Boat Captain Registration (INTERNAL/SCSO Employees)

  1. IMPORTANT: Please open this form in GOOGLE CHROME (Internet Explorer fails to submit properly).
  2. Boat Captain Registration Form

    Please don't bring your own boat - pontoons will be provided.  Participants will meet at 6:30 a.m. at the Cedar Lake picnic shelter in New Prague. Award Ceremony at 1:30 p.m.

  3. Which are you signing up for?*
  4. Supervisor has given me permission to volunteer for this event *
    (Permission is required if it interferes with your work shift)
  5. T-shirt Size*
  6. Have you participated in this event in the past?*
  7. Photo & Video Release
    During this Youth Fishing Derby event, I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio, video, or other media without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. By signing this release I understand this permission signifies that photographic or video recordings of me and may be electronically displayed via the Internet or in the public setting. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. By typing my name below, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for promotional and/or educational purposes.
  8. Do you agree to the Photograph & Video Release?*
  9. Thank you for your interest becoming a Boat Captain for the Youth Fishing Derby! Your information will be forwarded to the event coordinator. You will be notified shortly as to whether your request can be accommodated. If you have any questions, please contact Dennis Tietz at 952-496-8724 or
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