EB2Gov POS

East Kingston Recreation

Annual Fising Derby

*** NEW DATE OF APRIL 27th ***

Saturday April 27th from 8:00 to 11:00 AM

Foss Wasson Field Pond
8 Main Street, East Kingston NH

Open to all kids ages 3-15. Must be accompanied by an adult

$10 for EK Residents / $15 for Non-EK Residents

Registrations closes April 22nd

East Kingston Recreation

Annual Fising Derby

*** NEW DATE OF APRIL 27th ***

Saturday April 27th from 8:00 to 11:00 AM

Foss Wasson Field Pond
8 Main Street, East Kingston NH

Open to all kids ages 3-15. Must be accompanied by an adult

$10 for EK Residents / $15 for Non-EK Residents

Registrations closes April 22nd

Fishing Derby Registration

Parent Name:

Parent Email:

Parent Phone:

Street Address:

Town:

Zip Code:

East Kingston Resident:

Child's Full Name:

Date of Birth (MM/DD/YYYY):

School:

Age:

Allergies / Limitations:

East Kingston Resident:

Child's Full Name:

Date of Birth (MM/DD/YYYY):

School:

Age:

Allergies / Limitations:

East Kingston Resident:

Child's Full Name:

Date of Birth (MM/DD/YYYY):

School:

Age:

Allergies / Limitations:

East Kingston Resident:

Child's Full Name:

Date of Birth (MM/DD/YYYY):

School:

Age:

Allergies / Limitations:

Amount:

EB2Gov Fee:

Quantity:

Payment Amount:

Notes:

I, the parent / legal guardian of the participant, a minor, agree that I hereby release, discharge and /or otherwise indemnity the East Kingston Recreation Department, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for Recreation Department activities against any claim by me or on behalf of the participant as a result of the registrant's participation in East Kingston Recreation programs and activities and / or being transported to or from the same, which transport ion I hereby authorize.

Parent / Guardian Information

Child #1

Child #2

Child #3

Child #4

Transaction Details