2021 Canoe & Swift Water Rescue Course Registration Form

2021 Canoe & Swift Water Rescue Course Registration Form
Personal Information

Please fill as completely as possible
Full Name *

First Name Last Name
Phone Number *

Area Code
E-mail *
Cell Number *

Area Code Phone Number
Address

Street Address

Street Address Line 2

City Province/ State

Country
Age
Weight (lbs) *
Height (feet) *
Swimming Ability *
Wetsuit/Drysuit *

Will use a wetsuit I will rent a drysuit I have my own
Newsletter

Yes, add my email to the Yukan Canoe Newsletter
Are you Registering Additional People on this Form

Yes No
Additional People you are registering with this form
Medical and Emergency Contact Info for all Registrations
Medications *
Medical Conditions *
Emergency Contact person *

First Name Last Name
Medical Information for all Registrants including Allergies
Phone Number *

Area Code Phone Number
Relationship
Course Selection

Please pick your course dates below. You will then need to select and pay for course in Course Payment Section
Intro to Moving Water Level 1 Thursday Evening all day Sat/Sunday

May 6,8,9 May 13,15,16 May 28,29,30 June 3,5,6 June 10,12,13 June 17,19,20 July 15,17,18
Intro to Moving Water Level 1 Friday Evening all day Sat/Sunday

May 21,22,23 May 28,29,30 June 4,5,6 June 11,12,13 June 18,19,20 June 25,26,27 July 9,10,11
For 2021 we have course start days on either Thursday or Friday evening. We require a minimum of 4 people per course. Are you flexible for either Thurs or Fri evening?

Yes No
Whitewater Fundamentals Level 2 Thursday Evening, all day Sat/Sunday

May 27, June 5,6 June 10,12,13 June 24,26,27
Whitewater Fundamentals Level 2 Friday Evening, all day Sat/Sunday

June 4,5,6 June 18,19,20
Whitewater Skill Building Series- Solo

May 8 May 15 May 22 May 29 All
Whitewater Skill Building Series-Tandem

May 6 May 13 May 20 May 27 All
Lapie River Extravaganza - 4 day whitewater course

June 26,27,28,29 July 1,2,3,4 July 8,9,10,11
Swift Water Rescue - 2 Evenings 2 Full Days

May 19,21,22,23 May 26,28,29,30 June 9,11,1213 June 15,16,17,18
Intro to Solo Playboat

May 17,18,20,24 June 15,16,18,21 Custom dates please email
Intermediate Solo Playboat

June 16,17,21 Custom Dates Please Email
Advanced/Intermediate Solo Playboat- Lapie River

July 8,9,10,11 Custom Dates Please Email
Solo-Tripping Canoes

May 20,23,24 June 17,20,21 Custom dates Please email
Extra Information for Custom Courses or other details we should be aware of before the course.
Extra Student Details- Include information like: friends that are signing up for same course, mobility challenges, Custom course info, etc.
If the course you have chosen does not have the required minimum of 4 students are you willing to pay 25% more so the course can run? We are offering this option to be able to have more courses run. Asking on this form will save us from asking later in the case of low registrations.

Yes No
Online Payment Section- Pay for your courses here. All students will be required to sign a waiver. Please read our cancellation policy before registering.

Pay for all participants registered on this form.

COURSE ONLINE PAYMENT SECTION

Deposit for Courses

Deposit for Course (other than Lapie) Pick either deposit or full course payment. NOT BOTH $ 100.00 CAD

Deposit function only available till April 30

Quantity
Item subtotal: $ 0.00 CAD

Deposit for Lapie River Extravaganza $ 250.00 CAD

Quantity
Item subtotal: $ 0.00 CAD

Tandem Canoe

Intro to Moving Water $ 249.00 CAD

Quantity
Item subtotal: $ 0.00 CAD

Whitewater Fundamentals Level 2 $ 299.00 CAD

Quantity
Item subtotal: $ 0.00 CAD

Lapie River Extravaganza $ 499.00 CAD

Quantity
Item subtotal: $ 0.00 CAD

Solo Canoe

Intro to Whitewater Solo Playboating $ 299.00 CAD

Quantity
Item subtotal: $ 0.00 CAD

Intermediate Whitewater Solo Playboating $ 299.00 CAD

Quantity
Item subtotal: $ 0.00 CAD

Intermediate/Advanced Solo Playboat $ 499.00 CAD

4 day whitewater course

Quantity

Swift Water Rescue

Swift Water Rescue $ 299.00 CAD

Quantity

Drysuit + Booties

Drysuit rental $ 35.00 CAD

We will pick size based on height/weight on form.

Quantity
Item subtotal: $ 0.00 CAD

Bootie Rental $ 15.00 CAD

Old running shoes work well

Size Quantity
Item subtotal: $ 0.00 CAD

Neoprene Sock purchase $ 15.00 CAD

size Quantity

Enter coupon

Subtotal $ 0.00 CAD Tax $ 0.00 CAD Total $ 0.00 CAD

Payment Method

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Additional Information
Should be Empty:

2021 Canoe & Swift Water Rescue Course Registration Form

Personal Information

Medical and Emergency Contact Info for all Registrations

Course Selection

Extra Information for Custom Courses or other details we should be aware of before the course.

Online Payment Section- Pay for your courses here. All students will be required to sign a waiver. Please read our cancellation policy before registering.