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Fishing Program Report Form
Complete and submit this form after a program is completed
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* Required fields

E-mail address*
 
Program number*
Program date (xx-xx-xxxx)*

 

 

Start time       Stop time
a.m.
p.m.
   
a.m.
p.m.
County program was held in*
Program site (park, lake, etc)
Zip code
Instructor / leader first name
Instructor / leader last name
Instructor number
Number of program helpers or other instructors assisting
 
Assistant instructor first name
Assistant instructor last name
Instructor number
Assistant instructor first name
Assistant instructor last name
Instructor number
Program type?   I'm a SMART Angler   Ladies Introduction to Fly-Fishing
    Family Fishing Program   Introduction to Kayak Fishing
    Family Ice Fishing Program   Kids Fishing Derbies/Rodeos
    Introduction to Fly-Fishing   Introduction to Fishing Activity
          Other
            If other, specify
 
   
Number pre-registered
Program attendance (total people not counting helpers or instructors)
Please estimate the attendance in each of the age categories below
Younger than 16   35-64
16-17   65 and older
18-34      
Comments
Weather   Sunny     Rain     Cold  
    Cloudy     Windy     Warm  

Thank you for taking the time to complete this survey.
After submitting this form you will be taken to the PFBC home page.