Private Class Request Form
Please enter a valid Email address to be contacted by the program director
Email address *
Pricing
Price may change without notice
Name (First & Last, Please) *
Phone Number (optional)
Today Date *
MM
/
DD
/
YYYY
Number of People in your group (same household). 1:4, instructor:student radio *
Required
IF 2 +: Does everyone live in the same household? If NO...I am sorry we are only accepting group living the same Household. This Exclude Social Bubble Group. *
Anyone in your group under 18 years old? (If YES, a legal guardian must be present and participate in the class. *
Age of Each Youth. (Optional if >18)
Location Prefer? *
I am interesting In the following class (Please choose 1) *
Your prefer start time: (A full day class must start at 9:00 AM) *
What would you like to gain from this class? Please provide any information that you think will help us make your kayaking experience more successful. *
PRIMARY DATE: When is the earliest date you available? 2 weeks lead time prefer. *
ALTERNATIVE DATES: (We have Limited # of instructor. Please provide at least 3 alternative dates.) *
Skill Level (optional)
Beginner
Intermidiate
Advance
I consider my skill a
Do you have your own gear? *
Required
If YES, please provide the MAKE and MODEL below and Any additional gear you have.
I acknowledge that I read the statement below: Please note, due to the COVID-19 pandemic, we are monitoring our Public Health Agency closely to make sure that we are following all necessary precautions. This may include suspending any scheduled classes with very little notice. Any classes California Canoe & Kayak cancels will either be rescheduled or refunded. If you are cancelling or rescheduling a class. I also understand that CCK May not be able to guarantee the dates I have choose (primary or alternates). *
Required
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