STARS AMONG US

OF MARION COUNTY, INC.

INCLUSION WITHOUT LIMITS

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Fishing with the Stars

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Fishing with the Stars

Participant First Name*

Participant Last Name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Is participant under the age of 18?*

Yes

If yes, what is the participants age?

Phone*

Email*

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Phone*

MEDICAL INFORMATION (Optional): Please list any allergies, medical conditions, mobility needs, seizures, or other information our volunteers should know in case of an emergency.

ACCOMMODATIONS: Please let us know if there are any accommodations that would help make your day more enjoyable.

T-SHIRT SIZE: Free Event T-Shirt with Pre-Registration before September 30, 2026*

PHOTO & VIDEO RELEASE: I give Stars Among Us permission to use photographs or video taken during the event for promotional purposes.

Yes, I give permission.

No, I do NOT give permission.

ADDITIONAL INFORMATION: Will a parent, guardian, or caregiver be attending with you?

Yes

If yes, Name:

IMPORTANT SAFETY ACKNOWLEDGEMENT: I understand that fishing equipment contains sharp hooks and that I agree to follow all instructions from event staff and volunteers for the safety of myself and others.

I understand and agree

PARTICIPANT AGREEMENT & LIABILITY WAIVER: By submitting my registration, I acknowledge and agree to the following. (All boxes MUST be checked)*

I understand that participation in the 1st Annual Fishing with the Stars involves outdoor activities and fishing equipment, including hooks, which may present risks of injury.

I voluntarily assume all risks associated with my participation in this event.

I agree to follow all event rules and instructions from event staff and volunteers.

I release, discharge, and hold harmless Stars Among Us of Marion County, Inc., along with its directors, volunteers, sponsors, the City of Belleview, and others connected to this event, from any liability, claims, damages, or causes of action related to my participation, except where such issues are caused by gross negligence or intentional misconduct of the released parties, as prohibited by law.

I authorize emergency medical treatment for myself or the participant if I cannot be reached.

I understand that photographs or video may be taken during this event and used for promotional purposes unless I have indicated otherwise.

Participant Signature or Parent/Guardian (if participant is under the age of 18)*

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PARTICIPANT REGISTRATION

STARS AMONG US

OF MARION COUNTY, INC.

INCLUSION WITHOUT LIMITS

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Fishing with the Stars

CONTACT

(352) 425-3530

info@starsamongus.net

2855 SE 145th Street, Summerfield, FL 34491

Stars Among Us of Marion County

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Email*

Yes, email me about future events.