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Corrib Canoe Summer 2017
Parent or Guardian Name (junior course only)
Name
Name (registering second person)
Name (registering third person)
Name (registering fourth person
Age (minimum 8 years old)
Contact Number
Email
Address
Date of Course (please phone to ensure availability
MM
/
DD
/
YYYY
Course Time
Any medical conditions we should be aware of? (if this does not apply please just type N/A)
Are you comfortable in the water?
If applicable what years did you previously attend Corrib Canoe
Method of payment for deposit
How did you hear about Corrib Canoe Courses?
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