2023 Viking Canoe Club Beginner Clinic

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Please fill all required info questioned below and make sure to type your full name, date and age at the very end of this form. Cost of the clinic is $65.00 and you must be a member of the Viking Canoe Club. If you don't have a membership with the VCC , you'll need to join here... https://vikingcanoeclub.info/join/ There will also be a $10.00 fee for insurance unless you’re a member of the ACA. You can join the ACA here if you'de like to help out... https://americancanoe.org/join/individuals/. The link to pay to participate in the beginners clinic will be posted after you complete and sign the form.

Email *

First Name *

Last Name *

Are you a Viking Canoe Club member? *

Yes

Are you member of the ACA (American Canoe Association) americancanoe.org *

Yes, I'm an ACA member - Please provide your membership card if so.

No, I'm not a ACA member https://waiver.smartwaiver.com/w/612e51630b072/web/ $10.00

Phone Number - Please include your area code. *

Age at time of the Clinic - Clinic date is June 4 & 5. *

Minor 17 or younger (must be accompanied by an adult at all times)

Adult 18 and Older

Height *

Weight *

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.) *

Yes

No, but I have access to one

No, I will need to rent one from Canoe Kentucky.

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. *

Whitewater paddle

Whitewater helmet

Whitewater PFD (personal flotation device)

Whitewater spray skirt that fits your boat and your waist

Appropriate shoes (booties or kayak specific shoes)

Dry suit

Wetsuit

I own nothing and will need to borrow or rent all gear

Required

How well can you swim? *

Beginner

Intermediate

Advanced

Roll Ability? *

I have a strong combat roll in class III whitewater

I can roll in whitewater/moving water but not consistently

I have a solid pool roll but not in moving water

I have an inconsistent pool roll

I've worked on a roll but don't have one yet

I have no idea what a combat roll is

Describe your current kayaking skill level. ie... like never kayaked / recboated on flatwater / whitewater *

Class Level... *

Beginner Stuff... Outfitting the Boat, Boat Control, Reading Flow, Eddie in & Peel Out.

Intermediate Stuff.. Surfing, Combat Rolls, Bracing, Ferring

If you have kayaked whitewater before, what rivers or creeks have you paddled? Leave blank if nil.

Are you interested in paddling on Sunday? *

Yes

Maybe

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. *

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