NOMINATION APPLICATION

Welcome to The FYSH Foundation Participant Application!
 
We are very glad to know you are interested in participating in our program and finding your own happiness in the outdoors.
Please carefully read this application and make sure the information you provide is complete and accurate.
If you have any question or issues, do not hesitate to reach us at help@fyshfoundation.org

 

 

Nominator *

Please provide the information of the individual filling out this form:

First Name * ______________________________________________________

Last Name * ______________________________________________________

Address (no PO Boxes) *

     Address _________________________________________________________

     City _____________________________________________________________

     State ____________________________________________________________

     Zip Code _________________________________________________________

     Country __________________________________________________________

Cell Phone * ________________________________________________________

Email * _____________________________________________________________

Relationship to Nominee * __________________________ 

 

Nominee *

Please provide information for the individual being nominated for a FYSH Foundation outing:

Age * _____________

First Name * ______________________________________________________

Last Name * ______________________________________________________

Address (no PO Boxes) *

     Address _________________________________________________________

     City _____________________________________________________________

     State ____________________________________________________________

     Zip Code _________________________________________________________

     Country __________________________________________________________

Cell Phone * ________________________________________________________

Email * _____________________________________________________________

 

If possible, please have nominee fill out this section

Essays are the opportunity for you to differ yourself from others and shine. Be direct, descriptive, and creative. This is your time! Your Personal Statement is very important for us to better understand who you are and how we can help you.

Please write your Personal Statement in no less than 250 words and more than 650 words, letting us know WHY you would like to receive a day of fishing or an outdoor experience with the FYSH Foundation *

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What days are you available to fish or an outing? *

____ Monday
____ Tuesday
____ Wednesday
____ Thursday
____ Friday
____ Saturday
____ Sunday

 

MEDICAL CONCERNS

Our outings can be physically tiring, even exhausting. The facility or activities may require nominee to manage uneven terrain, be at a high altitude, require hiking, climbing, running, swimming, lifting, stairs, and other strenuous activities depending on the activity. Your medical condition (physical fitness, recent or chronic injuries, allergies, physical or emotional limitations, etc.) and even the medications you take may be affected by the activities, the altitude, or the emotional challenges.

Do you have any medical conditions, allergies or concerns, or are you taking any medications that you believe could prevent you from being an effective participant that we need to know about in order to help you have the best day possible? *

____ Yes
Please describe: __________________________________________________
____ No

        

Can you swim? *

____ Yes
____ No
Can you stand for extended periods of time? *
____ Yes
____ No
Photo Release

I hereby grant permission to the FYSH Foundation to use photographs and/or video of the participant, including minors, named on this application in publications, news releases, online, and in other communications related to the mission of the FYSH Foundation.

____ Yes
____ No

 

Emergency Contact:

Relationship to you * ______________________________________________

First Name * ______________________________________________________

Last Name * ______________________________________________________

Address (no PO Boxes) *

     Address _________________________________________________________

     City _____________________________________________________________

     State ____________________________________________________________

     Zip Code _________________________________________________________

     Country __________________________________________________________

Cell Phone * ________________________________________________________

Email * _____________________________________________________________

 

If you are under the age of 18 we must contact a parent or guardian for approval of participation:

Parent/Guardian

First Name * ______________________________________________________

Last Name * ______________________________________________________

Address (no PO Boxes) *

     Address _________________________________________________________

     City _____________________________________________________________

     State ____________________________________________________________

     Zip Code _________________________________________________________

     Country __________________________________________________________

Cell Phone * ________________________________________________________

Email * _____________________________________________________________

 

By clicking Submit below, I hereby affirm that the statements made on this application are true. I understand that this is a non-paid volunteer position. If selected, I agree to act in the best interest of the FYSH Foundation. I understand that this personal information will be held confidential by the FYSH Foundation.

____ I agree with the statement above (initial) *

_________________________________________________________________________________

Signature & Date

 

Please email completed Nomination Application forms to: help@fyshfoundation.org

(all fields with asterisk are required. Incomplete application will not be considered.)