2022 Course Registration Form

2022 Course Registration Form

Canoe + SwiftWater Rescue
Personal Information

Please fill as completely as possible
Full Name*

First NameLast Name
Phone Number*

Area Code
E-mail*
Cell Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityProvince/ State

Zip CodeCountry
Age
Weight (lbs)*
Height (feet)*
Swimming Ability*
Will use a wetsuitI will rent a drysuitI have my own
Yes, add my email to the Yukan Canoe Newsletter.
YesNo
Additional People you are registering with this form
Medical and Emergency Contact Info for all Registrations
Medications*
Medical Conditions*
Emergency Contact person*

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

Area CodePhone Number
Relationship
Course Selection

Please start by selecting the type of courses(s) you're registering for. Next, pick your course dates below. You will then need to select and pay for course in the Course Payment Section
Intro to Moving WaterWhitewater Fundamentals Level 2Lapie River ExtravaganzaSwift Water RescueIntro to Solo PlayboatIntermediate Solo PlayboatAdvanced/Intermediate Solo Playboat - Lapie RiverSolo - Tripping CanoesFrench Speaking Courses
June 9,11,12June 16,18,19
June 10,11,12June 17,18,19June 24,25,26custom dates availableOther
May 27,28,29 (Friday evening)
YesNo
June 9,11,12June 16,18,19Other
June 10,11,12June 17,18,19(wait list)June 24,25,26 (could be high water challenges)
May 8May 15May 22May 29All
May 6May 13May 20May 27All
June 24-27 (cancelled)June 30-July 3(wait list)July14-17Other
custom dates may be availableOther
May 16,17,18,23other dates by interest
June 16,17,21Custom Dates Please Email
June 30- July 1,2,3additional dates by interest
June 9,11,12additional dates by interest
see packraft registration form
see packraft registration form
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.
Yukon NewsWhitehorse Star onlineGoogle SearchCKRWPostersFriendsword of mouthKanoe PeopleUp NorthPadding Mag.North of OrdinaryWhat's Up YukonEmail campaignMedia screensOnline advertisingYCKCOther
YesNo
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

Tandem Canoe

Intro to Moving Water$279.00CAD

Quantity
Item subtotal:$0.00CAD

Whitewater Fundamentals Level 2$349.00CAD

Quantity
Item subtotal:$0.00CAD

Lapie River Extravaganza$575.00CAD

Quantity
Item subtotal:$0.00CAD

Solo Canoe

Intro to Whitewater Solo Playboating$349.00CAD

Quantity
Item subtotal:$0.00CAD

Intermediate/Advanced Solo Playboat$575.00CAD

4 day whitewater course

Quantity

Intro to Solo Tripping$349.00CAD

Solo Tripping Canoe Course taught is regular size canoes

Quantity
Item subtotal:$0.00CAD

Swift Water Rescue

Swift Water Rescue$349.00CAD

ACA certificate of Participation

Quantity
Item subtotal:$0.00CAD

Swift Water Rescue Assesment$50.00CAD

American Canoe Association Membership required to have skills assessment during the course. Must be selected before start of the course.

Quantity
Item subtotal:$0.00CAD

Drysuit + Booties

Drysuit rental$45.00CAD

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

Quantity
Item subtotal:$0.00CAD

Bootie Rental$15.00CAD

Old running shoes work well. Please indicate size for each rental. We only have unisex and full sizes

QuantitySizeSizeSize 2Size 3
Item subtotal:$0.00CAD

Neoprene Sock purchase$25.00CAD

sizeQuantity

Enter coupon

Subtotal $0.00CADTax $0.00CADTotal $0.00CAD

Payment Method
Credit	Express

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:

2022 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.