Registration Information:
Who are you registering?
(Required)
I am registering just myself
I am registering my child/children
I am registering both myself and my child/children
Phone number
(Required)
Email
(Required)
Name
(Required)
First
Last
Name of parent/guardian attending
(Required)
First
Last
Name of parent/guardian participating
(Required)
First
Last
How many total parents/guardians will be participating?
(Required)
1
2
3
4
Children:
Number of children participating
(Required)
1
2
3
4
Name and age of child
(Required)
For example: Joey Smith Jr., 10
Name and age of second child
(Required)
Name and age of third child
(Required)
Name and age of fourth child
(Required)
Participant Information:
Please answer these survey questions from the perspective of the clinic participant(s).
Do any of the following people in your life fish? (select all that apply)
(Required)
Father/mother
Brother/sister
Spouse
Friends
Grandparent
Other relatives
None
To what degree do you think your family, friends, and/or peers enjoy saltwater fishing?
(Required)
Really enjoy
Enjoy
Somewhat enjoy
Do not enjoy
In your lifetime, how many times have you saltwater fished?
(Required)
Never
1-4 times
5-9 times
10+ times
How likely are you to go saltwater fishing within the next 12 months?
(Required)
Very likely
Likely
Somewhat likely
Not likely at all
What is your primary reason for learning to saltwater fish?
(Required)
Have an interest and want to build skills and confidence
Refresher on skills (have not saltwater fished in a long time)
To harvest my own source of food
To spend time with friends and family
To pass saltwater fishing onto my children and grandchildren
Other
How did you find out about this angler education program?
(Required)
MA DMF newsletter
MA DMF email
MA DMF website
Word of mouth
At a MA DMF event booth
Facebook or Instagram
Other
Final Steps
Liability and Photo Release Waiver
(Required)
I, in connection with my or my child/children’s participation in events held by Division of Marine Fisheries (DMF) do hereby release the Commonwealth of Massachusetts, DMF, and its employees, permittees, vendors, agents, representatives, volunteers and other governmental entities working for or with DMF (“Providers”) from any and all liability, loss, damages, costs, claims and/or causes of action, including but not limited to property damage and emotional and bodily injuries, including death, arising in any way from my or my child/children’s participation in any program, course or recreational activity of every type and description provided or sponsored by DMF.
I understand that participation in such program, course or recreational activity may involve risk and the possibility of injury to me or my child/children, and to others, and of property damage. I hereby release and hold the Providers harmless from liability for any such injury or damage, including any injury that may occur as a result of emergency care provided by the Providers. I also hereby indemnify the Providers from any liability, loss, damages, costs, claims and/or causes of action brought by my or my child/children’s participation, and from claims of others who me or my child/children injure while participating in such program, course or recreational activity, including any injury that may occur as a result of emergency care provided to others by the Providers.
I further understand and agree to abide by the general rules of conduct prescribed for the guests of MA DMF and violations may results in a denial of privileges, a forfeiture of all fees paid, and immediate removal from the hosting property.
Photograph/Video Authorization and Release
I do hereby authorize the Division of Marine Fisheries (DMF) to use any photograph, video or my or my child/children’s likeness(es) for promotion of the DMF’s activities, properties, facilities or functions in any public format, including but not limited to publication on the DMF Website, Facebook or other social media website utilized by DMF, brochure or other publication and/or press release. I understand that such promotion will be disseminated to the public and may be copied or otherwise reproduced. I hereby release the DMF from any liability that may arise from the photograph, video or likeness of the subject in such promotion, and from any liability that may arise from the dissemination of such promotion to the public or the use of the promotion by the public.
By checking the box below, I attest I have read this release, understand it affects legal rights and responsibilities, and agree to the terms & conditions. This release form is valid for 1 year (365 days) from the date of submission.
By checking this box, I attest I have read this release, understand it affects legal rights and responsibilities, and agree to the terms & conditions. I waive any claims arising while participating in the programs of MA DMF.