Age at time of the Clinic - Clinic date is June 4 & 5. *
Emergency Contact, Relationship & Phone Number *
Please list and explain any medical conditions or life threatening allergies that could affect your safety in the field (the field being the river or camping area) All medical conditions will be kept confidential except to an EMT, Nurse or Doctor. If NO please put N/A. *
Please describe any special diets or food allergies that we should be aware of for purchasing food during the days we are camping (vegetarian, lactose intolerant, peanut allergies, etc.) If NO please put N/A. *
Do you own your own whitewater kayak for the clinic? (All kayaks sold by chain stores such as Dicks, Cabela's, Bass Pro, etc. are recreational kayaks and not suitable for whitewater.) *
If you do own a whitewater kayak and you plan on using it for the clinic please list the brand & model name below. If you don't know at this time please put N/A or leave blank.
Do you own any whitewater gear? Select all that you own. *
How well can you swim? *
Roll Ability? *
Describe your current kayaking skill level. ie... like never kayaked / recboated on flatwater / whitewater *
Class Level... *
If you have kayaked whitewater before, what rivers or creeks have you paddled? Leave blank if nil.
Are you interested in paddling on Sunday? *
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. Please type your name, date and age in the response window if you agree to the terms and conditions. This will also be signed in person the day of the clinic before entering the river. *