REGISTER

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Registration Form

Please complete the form below to start your registration. A representative will contact you to discuss payment and to confirm your reservation.

Please be sure that you have read the registration information and safety page prior to submitting your registration to us. Thank you.

Please fill out the form completely as we need some of the information for equipment sizing and your comfort on the water.

Name:
Address:
City:
Province: (required)
Postal Code:
Phone:
Emergency contact (Name and Number)
E-Mail Address:(required)
Age:
Height:
Weight:
Occupation:
Previous paddling experience:
Participation in other water oriented sports:
Reason for taking this course:
Expectations from this course:
How did you find out about us?
Course Interest:	Introductory Pool Session Give it a Whirl Advanced Beginner Intermediate Clinic River Rescue Rolling Sessions
Course Date:
MEDICAL HISTORY
Allergic Reactions:	Bee Stings Penicillin Other
General Physical Condition:	Good Fair Poor
Chronic Disabilities:	Hearing Respiratory Circulatory
Please specify:
Sight:	20/20 Glasses Contacts
Swimming Ability:	Good Fair Poor
Please advise if you have any shoulder problems:
General questions or concerns you may have: