Contact Info *

First Name

Last Name

Age Range *

10-20

20-30

30+

Phone/Text *

(###)

###

####

Class / Trip Date *

MM

DD

YYYY

Goals for Your Fly Fishing Experience *

Select the main reason(s) you booked this trip (choose up to 3).

🎯 Learn or improve my casting technique

🐟 Catch my first fish on a fly rod

🌊 Gain more confidence wading or fishing moving water

🔍 Learn about local fish species and the environment

🎣 Improve my fly selection and presentation

🛠️ Learn how to set up and use my gear effectively

📸 Enjoy the scenery and have a relaxing day outdoors

👥 Share a memorable experience with friends/family

❓ Other (please describe below)

Any medical conditions we should be aware of? *

e.g. Diabetes, mobility restrictions, cardiac, seizures etc.

Yes

No

Do you take any medications? *

Please list any relevant medications to this event such as seizure medication, insulin for diabetes etc.

Yes

No

Do you have Anaphylaxis? *

Do you have Anaphylaxis to bee stings or other environmental or food sources?

Yes

No

Emergency Contact info *

First Name

Last Name

Phone *

(###)

###

####

Liability Waiver & Release *

I understand that fly fishing involves risks (e.g., slips, weather hazards, wildlife, equipment accidents) and voluntarily assume these risks. I affirm I’m fit to participate and will bring necessary medications. I authorize staff to assist with my meds in emergencies (not as medical professionals) and to seek medical help if needed, at my expense. I release Fly Fishing New England, Stephen Rock, and affiliates from liability for injury, loss, or damage during this activity. I agree to conduct myself in a professional, respectful, and responsible manner during all activities. I will abstain from using drugs or consuming alcohol and will treat my guide, fellow participants, and the environment with courtesy and respect. I understand that failure to do so may result in my removal from the activity without refund.

I Agree & Approve

Wader Rental

Equipment Rental Acknowledgment (Waders): If I choose to rent waders or related equipment from Fly Fishing New England, I acknowledge that this equipment is provided “as is” and may carry inherent risks, including but not limited to slips, falls, leaks, cold exposure, or other hazards that could result in injury. I accept full responsibility for my decision to use rented equipment and agree that I will inspect it before use. I release Fly Fishing New England, Stephen Rock, and affiliates from any liability for injury, illness, or damages arising directly or indirectly from the use, failure, or condition of rented waders or related equipment.

I agree & Approve

Sharing Photos (optional) *

We love capturing special moments on the water! From time to time, we may share photos of trips (like a proud catch or a scenic river shot) on our website or social media. - We Will send the photos to you. - Your name will never be shared without your permission. - You can always ask us to remove a photo later if you change your mind.

Yes, I’m happy for Fly Fishing New England to use photos/videos from my trip.

No, please don’t use my image.