SRCC Summer Program Registration
Dates: May 15, 2017 to August 18, 2017
Boathouse Address: 822 Avenue H South
Mailing Address: Box 31007, Saskatoon, SK S7H 5S8
Contact us at (306) 668-7722 or srcc_registration@outlook.com
Please note: Calls and emails will be returned in the evenings.
Email address
Participant First Name
Your answer
Participant Last Name
Your answer
Gender Identifed with
Date of Birth
MM
/
DD
/
YYYY
Swimming Level
Your answer
Program Choices
*** All Classes require a minimum of 5 participants. SRCC will mix Youth and Adult or combine two sessions to obtain the appropriate number of participants. ***
Kayak Session Choices ($25 cancellation fee)
Date of Session
Method of Payment
Groupon #
Your answer
Household/Adult Primary
First and Last Name
Your answer
Relationship to Participant
Address
Your answer
Contact Phone Number
Your answer
Email address
Your answer
How did you hear about SRCC?
Medical Fitness and Treatment
I am fully aware of the nature of the SRCC Programs in which I may participate, and I am of the informed opinion that I am qualified, in good health, and in proper physical condition to participate in such Programs. I further agree and warrant that if at any time I believe that my health and physical condition have changed such that it would be unsafe for me to continue to participate in the Programs, I will immediately discontinue my participation. I hereby give my consent to have any coach, assistant coach, trainer or other SRCC official act as my surrogate in securing ambulance service and to have an athletic trainer and/or doctor of medicine or dentistry provide me with medical assistance and/or treatment under whatever conditions are necessary to preserve my life, limb or well-being. Such consent shall not, however, establish a fiduciary relationship, nor be considered a power of attorney or health care proxy. I further agree to be responsible financially for the cost of each assistance and/or treatment rendered. I understand and agree to the Medical Fitness and Treatment clause:
I acknowledge that I have read and understand this agreement, and that I am agreeing to abide by its terms.
Required
Being a parent or legal guardian of the above noted participant, I agree that the Participant's Agreement and Acknowledgement of Risk shall be binding upon my child or ward.
Permission to Use Photographs or Television
I grant to SRCC, its representatives and employees the right to take photographs of me and/or my child in connection with participating in kayaking with SRCC. I authorize SRCC, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that SRCC may use such photographs or other media, such as Shaw TV footage of me or my child without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
I have read and understand the above
Permission to release your contact information to other members of the SRCC
I grant SRCC permission to share my phone number and email address with other members of the club. By sharing my contact information, other members are able to contact me for program or club related matters or assistance
I have read and understand the above
Participant Health Information
First Name and Last Name
Your answer
Emergency or Parent 1 Contact Name
Your answer
Emergency or Parent 1 Phone Number
Your answer
Emergency or Parent 2 Contact Name
Your answer
Emergency or Parent 2 Phone Number
Your answer
Saskatchewan Health Card #
Your answer
Allergies
Your answer
Disabilities
Your answer
Injuries or other medical information coaches should be aware of:
Your answer
FOR ADULT PARTICIPANTS
The following information is needed to ensure we have the proper kayak available for your use
Height
Your answer
Weight
Your answer
Any additional information?
Your answer
Procedure in case of Emergency
Your answer
Time to Enjoy the Beautiful Saskatchewan River!
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