Information and Consent Form

Adult or Child's Last Name*

Adult or Child's First Name*

Date of Birth*

dd/mm./yyyy

Gender

M or F

Can the child swim?*

YesNo

Left or right handed?

LR

Angling experience

New - starterIntermediateExperienced

Child's Parent / Guardian Name*

First NameLast Name

Adult or Child's Home Address*

Address 1

Address 2

Village/Town

Post Code

Adult or Parent/Guardian Email*

example@example.com

Adult or Parent/Guardian Home Phone Number

Adult or Parent/Guardian Mobile Number

Alternative Emergency Contact Name and Mobile Number

How did you hear about us?*

Child's relevant Medical Information (including allergies) and if the child's own medication is needed during the day.

including sun cream, hand sanitiser, insect repellents, insect bite relief, plasters. All will be applied for the student, if needed. We can remind the child about their medication but not administer

If own medication is needed during the day.

We can remind the child but not administer

Any Child's relevant Behavioral Issues

That the Coaches should be aware of

We will adhere to the Angling Trust’s Child Protection Policy. I consent to my child taking part in activities with us. Especially younger pupils may be given a hand into their swim/platform for safety, and help given on tasks such as on casting, positioning the rod or pole, and “striking” to hook the fish.

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

Childs protective clothing including sun hat, sunglasses, waterproofs when appropriate, non-slip shoes or boots for any muddy conditions should be worn. Suncream to be applied. Suitable food & drink (screw-top best, wasps can get in a can!) also to be provided.

For the purposes of coaching, all participants are automatically covered by the Angling Trust’s Insurance scheme

I consent to photographs and/or video of my child on the understanding that any images will be used solely for the purpose intended. We will follow guidance for the use of any images as detailed in the Angling Trust’s Child Protection Policy.*

YesNo

Consent for the Angling Trust & Environment Agency to contact you*

YesNo

Media Policy: Available and has been explained*

YesNo

Been fishing before?*

YesNo

Registered Disabled?*

YesNo

Has a long-term illness?*

YesNo

Black / Other minority ethnic background*

YesNo

EA Rod Licences

Temporary rod licences are issued for all of our main coaching days at no
charge.
If though you go fishing outside of these days you will need an EA
rod licence

Children under 12 however don’t need a licence.
Licences for children aged between 12 and 16 are free but this can only be done online. Make sure you connect to the www.gov website as there are a few sites that come up on a search engine that make an extra charge for getting your rod licence

www.gov.uk/fishing-licences/when-you-need-a-licence

Licence Type - Trout and Coarse Two Rod	Cost
Adult 1 day	£6
Adult 8 day	£12
Adult 12 month	£30
Adult 12 month - over 65 and disabled	£20
Junior (aged 13-16) 12 month	Free

Young Anglers Code of Conduct

1. During both theory and practical sessions the programme is sharing facilities with other people who may require a quiet environment. We expect students to respect this and adopt appropriate behaviour.

2. The use of offensive and/or discriminatory language is considered unacceptable.

3. All staff and students will respect each other, the environment in which they are in, wildlife and members of the public at all times. Bullying of any description will not be tolerated

4. Health and Safety procedures will be adhered to by all young persons and adults.

5. Deliberate damage to any item of tackle or equipment belonging to the Young Anglers, the fishery, staff or other students will not be tolerated. This could result in the parents or carers of the student receiving a bill to replace the item(s).

6. We reserve the right to exclude any young person from the programme for extreme cases of inappropriate behaviour. All young persons and staff are expected to follow the Young Anglers Code of Conduct.

To bring on the day

Seat
Plenty to drink (Screw top best. Wasps can get in cans)
Food
Waterproofs and adequate clothing
Boots or shoes with ribbed anti-slip soles
Antispectic hand gel
Hat, sunglasses and sun cream
Towel to clean hands after handling fish
Any medication required (we cannot adminster this)
Due to risk of disease transmission such as KHV please do not bring any keep-nets or landng nets. Also clean and dry boots - remove all damp mud.

The ACI follows the Angling Trust Health and Safety Policy, Equality Policy (also covers Discrimination, Harrassment and Victimisation) and the Coe of Practice for Sports Coaches. Full details on www.anglingtrust.net

Please note under the terms of the Data Protecton Act we are holding participants details on a restricted access database.

Please verify that you are human*