Nixa Public Schools

Student Information:
Name (Print):_______________________ Grade_______ Date of Birth ________
Cell Phone #:__________________________________
Email:________________________________________
2nd Email:_____________________________________
Address:______________________________________
_____________________________________________

How would you rate your fishing experience? 1 2 3 4 5 (with 5 being highest)
Have you ever fished in a tournament before? Yes No
Do you have your own rods and reels? Yes No
Do you have access to fish on your own time? Yes No

Parent Information:
Name (Print):_____________________ Name (Print):_____________________
Cell Phone #:_____________________ Cell Phone #:_____________________
Home Phone #:___________________ Home Phone #:___________________
Email:__________________________ Email:__________________________
2nd Email:_______________________ 2nd Email:_______________________

We have read the Nixa Bass Fishing guidelines and would like to join the club. We are familiar with the NHS Handbook and Citizenship/Drug Testing Requirements and agree to follow. We will complete the online MSHSAA Parent Meeting and ensure all FINAL FORMS requirements are completed within provided deadlines. We have received a copy of the Fishing Team Safety Requirements, understand them and agree to comply.

We understand the main requirement for team membership is each two person team is responsible for recruiting/providing a single Volunteer Boat Captain who is committed to them for all tournament dates and practices. The Volunteer Boat Captain must meet and comply with all school requirements to be eligible.

Must be a student enrolled in Nixa Public Schools.

Student Signature_____________________________________
Parent Signature______________________________________

Due with $50 club membership. Make checks payable to Nixa High School.