LOCK-CITY
MOOSE LODGE
AGE GROUPS
0-5
6-10
11-15
CATEGORIES
Bullhead & Catfish
Sheepshead
Pike & Walleye
Carp & Suckers
Bass
Pan Fish (Sunfish, Bluegills,
Rockbass, Perch, Crappie)
UNUSUAL (fish not listed)
ANNUAL FREE
KIDS’
FISHING DERBY
Sunday, June 19th, 2016
Free to all kids
15 years and under
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Bring your own tackle
Sign-ins start at 7:30 am and
fishing starts immediately
after sign-in
8:00 am - 11:00 am
Continuous weigh-ins
11:00 am Last weigh-in
11:00 am - 12:00 pm Lunch
will be served
12:00 pm - Presentation of
Awards and Prize Drawings
Sunday, June 19th, 2016
8:00 am – 1:00 pm
Wide Waters Marina
HOSTED BY
LOCK-CITY MOOSE LODGE #617
Printed materials for event donated by
Kax Solutions & Services
RULES
Contestants must be 15 years or
under by June 12, 2016 and
accompanied by a parent or
guardian. There must be at least
1 adult for every 3 children.
 Each entry will weigh fish
immediately after being caught.
Put fish in a pail of fresh water and
take it to the weigh station where
a representative will weigh it.
 Participants are encouraged to
release fish after weigh-in.
Handle fish gently.
 Only fish caught by hook, reeled
in, and presented by contestant
will be eligible (BANK FISHING
ONLY!)
 If fish is tampered with to affect
the weight, the entry will be
disqualified.
 Contestants must be holding the
rod when the fish is caught.
(Adults-let’s be fair. It’s a KIDS
event. Help them but don’t do it
all!)
 Winning entries will be based
solely on weight.
 No fish will be accepted for
weigh-in after 11:00 am
 Awards at 12:00 pm Noon
 Weigh Judges will decide the
winner. Their decision will be final.
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In order to prepare for the Derby, we must know how many kids and adults
are attending. Pre-registration is highly recommended to enable us to
determine the amount of food and prizes to have on hand.
OFFICIAL KIDS FIISHING DERBY REGISTRATION FORM
Child’s Name: ____________________________________________ Date of Birth: __________________
Address: __________________________________________________________________ Age: _______
City: _________________________ State: ______ Zip: ___________ Phone:______________________
RELEASE OF LIABILITY / PHOTO RELEASE
As a parent or guardian of the above named child, I certify that said child
has my permission to attend and participate in the above mentioned Kids’
Fishing Derby, to be held on the listed date, time and location. In signing
this form, I hereby waive and release all other participants, the host,
sponsors, and all other officials or parties involved in the Derby from all
claims and/or damages incurred in connection with this Kids’ Fishing Derby.
I also herby grant sponsor and co-sponsors the unconditional right to use
the name, voice and photographic likeness of the child in connection with
any of their audio/video productions, articles, or press releases, but not as
an endorsement.
________________________________________________________________
Parent or Legal Guardian Signature
__________
Date
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Child Signature
__________
Date
Registration forms MUST be filled out for all Contestants.
Please return registration by JUNE 5th, 2016 to
Moose Lodge 617, 204 Monroe Street, Lockport, NY 14094