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Child's First Name (future angler)
Child's Last Name (future Angler)
Child's Date of Birth
Child's Fishing Experience
Child has interest (now or in the future) in:
Dry Fishing Kit (Safe for Home/Hospital fishing pole and supplies that teach fishing basics)
Lake Fishing Events with Angling for Relief volunteers (entire family invited!)
Parent / Guardian's Name (primary contact for us)
Parent / Guardian's cell phone (or best phone)
Parent / Guardian's email
Home address (street, city, state, zip) for primary parent / guardian
Second Parent / Guardian Name (if applicable)
Is there anything else you'd like us to know?
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