2019 Yorkton Canoe Kayak Club Registration
Please use this online form for all programs (Dragon Boat, CanoeKids, Racing Program, General Membership). EACH MEMBER ON DRAGON BOAT TEAMS NEEDS TO FILL OUT REGISTRATION FORM.

You will be contacted if there is any issues with this Application for Membership.

Today's Date *
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Member/Participant's First Name *
Your answer
Member/Participant's Last Name *
Your answer
Member/Participant's Email
Your answer
Would you like to be notified via email about YCKC programs and upcoming events? *
Address *
Your answer
City *
Your answer
Province *
Postal Code *
Your answer
Member/Participant's Primary Phone Number *
Your answer
Secondary Phone Number (optional)
Your answer
Member/Participant's Date of Birth *
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Self Designation (Optional)
Emergency Contact (Name and Phone number) *
Your answer
Medical Limitations/concerns, medications, or allergies. (This information is confidential and will only be used to help our coaches provide a safe and adaptive environment for all participants) *
Required
Important Medical details:
Your answer
Do you give permission for YCKC to use your photo for promotional purposes. This may include: Video productions, website, Facebook, posters, brochures, etc. Names will NOT be used without further permission *
Would you like to purchase a YCKC T-shirt for $12?
T-shirt sizing (if applicable)
I am... *
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