Volunteer Coach Registration Form

Name

First NameLast Name

Address

Street Address

Street Address Line 2

City

Postal / Zip Code

Date of Birth

Date dd/mm/yyyy

Home Telephone Number

Mobile Telephone Number

E-mail

example@example.com

Please provide alternative emergency contacts details (Name & Telephone Number)

Are you a member of any of the following angling clubs

Known medical conditions (Information provided here will be kept in confidence)

Other relevant information (such as coaching qualifications, first aid, DB check held)

Angling Experience ( Please provide information on your angling experience).

Swimming Ability

How many days through the season (May to October) do you think you could attend volunteer sessions (Most run on Saturdays, although we do have a few run on week days during the school holidays)

Any venues you do not wish to fish:

Angling Coaching Initiative may take photos/videos during the coaching session for use on their website / social medial and advertising. Please indicate below whether you are happy to be included in any such media.

We acknowledge that we will be liable in the event of accident only if they have failed to take reasonable steps in their Duty of Care.

I confirm that, to the best of my knowledge I do not experience any medical issues other than those mentioned above. I consent to receiving medical treatment which, in the opinion of a qualified medical practitioner may be necessary.

Protective clothing of sun hat, waterproofs when appropriate, non-slip shoes or boots for any muddy conditions should be worn. Also suitable food & drink (screw-top best, wasps can get in a can!).

Please bring your own chair, tackle seat or other secure seat, as due to the space needed to transport seating these are NOT provided.

Due to the risk of disease transfer such as KHV please do not bring any keep-nets or landing nets ALSO clean & dry boots/shoes, remove all damp mud

Please verify that you are human