2018 Yorkton Canoe Kayak Club Registration
Today's Date *
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Member/Participant's First Name *
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Member/Participant's Last Name *
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Member/Participant's Email
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Would you like to be notified via email about YCKC programs and upcoming events? *
Address *
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City *
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Province *
Postal Code *
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Member/Participant's Primary Phone Number *
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Secondary Phone Number (optional)
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Member/Participant's Date of Birth *
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Self Designation (Optional)
Emergency Contact (Name and Phone number) *
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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) *
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Important Medical details:
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I give permission for YCKC to use my photo for promotional purposes. This may include: Video productions, website, Facebook, posters, brochures, etc. Names will NOT be used without further permission *
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