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.
Member/Participant's First Name
Member/Participant's Last Name
Would you like to be notified via email about YCKC programs and upcoming events?
Yes - Please confirm you have given a valid email above
Newfoundland & Labrador
Prince Edward Island
Member/Participant's Primary Phone Number
Secondary Phone Number (optional)
Member/Participant's Date of Birth
Self Designation (Optional)
Emergency Contact (Name and Phone number)
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)
N/A - I am able to fully participate in physical activity
Would prefer to discuss with coach in person
Allergies (Please complete next question)
Have had surgery which may affect ability to participate fully (Please complete next question)
Heart/ Cardiovascular Conditions
Visual Impairment (Please specify in next question how we can accommodate your needs)
Hearing Impairment (Please specify in next question how we can accommodate your needs)
Cognitive limitations (Please specify in next question how we can accommodate your needs)
Other Medial Limitations/concerns (Please complete next question)
I am not willing to disclose this information at this time
Important Medical details:
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)
Adult 2 XL
Adult 3 XL
Under 18 years of age
Over 18 years of age
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service