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2027 Fly Fishing Academy Application
"
*
" indicates required fields
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Parent or Guardian - Please Complete the Following Section
Parent or Guardians Name
*
First
Last
Home Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mobile Phone
*
Email
*
Emergency Contact Person - In Addition to Yourself
*
First
Last
Emergency Phone Contact - Different from your number above
*
How did you find out about the Northwest Fly Fishing Academy ?
Health Insurance Co. & Policy Number Required for the student applicant. - - - This information will remain private and only to be used in an emergency.
Has the applicant been vaccinated against Covid 19? - - - We strongly suggest that every student receive a Covid 19 vaccination and booster.
*
Yes
No
Student Age in June
*
We accept students who will be between 12 - 16 years of age during the academy. If an applicant is over 16 by a few months, we're flexible.
Tee Shirt Size
*
Youth - Small
Youth - Medium
Youth - Large
Youth - X Large
Adult - Small
Adult - Medium
Adult - Large
Adult X Large
Is the applicant a confident swimmer? Required for all lake fishing.
*
Yes
No
Does the applicant have any Allergies ?
*
Yes
No
Does the applicant have any Dietary Restrictions?
*
Yes
No
Is the applicant taking any Medications ?
*
Yes
No
Please provide any Allergy details, a List of Dietary Requirements and/or Medication Names, Dosages and Frequency. This information will only be shared on a need to know basis. A Co-Director will contact you to discuss medications in greater detail.
*
Please discuss any safe storage requirements you may have or any other medication concerns.
Is there anything else we should know about your child?
Student Applicant - Answer the Following Questions in Your Own Words
Student Name (Applicant)
*
Dr.
Miss
Mr.
Mrs.
Ms.
Mx.
Prof.
Rev.
Prefix
First
Last
We want to set up your reel according to your preference. ONLY ANSWER if you have fished before.
When I fish, I have my REEL'S HANDLE on my LEFT SIDE.
When I fish, I have my REEL'S HANDLE on my RIGHT SIDE.
How would you rate yourself as a fly fisher?
How would you rate yourself as a fly tier? No experience - tied a bunch of flies.
If you had the power, how would you help repair or improve a local fishery ?
Why should the academy accept your application ?
What makes you want to grab a fly rod and catch fish with a fly ?
What two fly fishing topics are you most interested in learning more about, at the academy?
Consent
*
I agree to the Rules of Conduct
Rules of Conduct
Revised August 2023
1. Follow the directions of the Senior Staff.
2. All students must be able to swim confidently. They will be given a short swimming test on day one of camp. The student’s performance during the swim test will directly affect their watercraft use privileges.
3. Students may not operate vehicles during the academy.
4. Students may not leave the academy grounds except during supervised field/fishing trips.
5. Apart from authorized parents or guardians, no one is allowed to visit the students while they attend the academy unless prior approval has been granted by the same.
6. Students shall not use a cell phone during class time or during a field trip, unless authorized by a staff member.
7. All accidents and injuries shall be reported immediately to a senior staff member. No injuries are to be considered insignificant.
8. Lost and found articles are to be delivered immediately to a senior staff member, the item will then be placed in a secure area for return to the owner.
9. Blades or knives of any kind are not permitted at the academy.
10. A student taking or requiring medication must list them on a form provided and submitted upon registration. Such information will be secured on site and shared only when necessary.
11. No tobacco products, of any form, are allowed on campus.
12. The possession or use of any controlled substance, alcoholic beverage or illegal material is not permitted and will be grounds for immediate dismissal from the academy.
13. Extra time to go fly fishing will be available during non-class times only when a senior staff member approves and can supervise your activity.
14. Student use of watercraft on Panhandle Lake is allowed only when supervised by a staff member.
15. When on the lake docks the students shall always wear their Personal Flotation Device
16. When using any watercraft on the lake the students shall always wear their Personal Flotation Device and lightweight footwear such as sneakers.
17. When wading the students shall always wear their Personal Flotation Device.
18. Swimming will only be allowed when a licensed lifeguard is on duty.
19. Appropriate language will always be expected and absolutely NO bullying is allowed.
20. Violation of any of the above rules may result in:
a. immediate dismissal from the academy
b. suspension from one or more classes or activities
If a violation occurs, the parent or guardian shall be notified “immediately” and the students academy fee will qualify for a pro-rated reimbursement.
I also agree to complete the academy in order to receive any awards or complimentary fishing equipment.
I have read “The Rules of Conduct” and will comply with all terms and conditions of the North West Youth Conservation and Fly Fishing Academy as called out above.
Date
*
MM slash DD slash YYYY
