EmailMe Form - Registration Form

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

After Filling out the form you will be directed to our registration page where you can pay the deposit to secure your spot.

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

Name *

Prefix

First *

Last *

Suffix

Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Phone Number

###

####

Email *

Emergency contact name

Emergency contact number

Age

Height
required for gear sizing

Weight
required for gear sizing

Swimming ability

Good

Fair

Poor

Previous paddling experience

Expectations from this course

How did you hear about us?

Course Interest

Pool Session

Introductory Course

Advanced Beginner Clinic

Intermediate Clinic

Rolling Clinic

River Rescue for River Runners

Course date

Medical Information

Allergies

Bee stings

Penicillin

Pets

Allergies other

General physical condition

Good

Fair

Poor

Chronic Disabilities

Hearing

Sight

Other

Please specify

Sight

20/20

Glasses

Contacts

Have you ever had any shoulder problems?
Please specify.

General questions or concerns you may have

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