2023 Paddle Canada Water Front Instructor Registration Form

2023 Yukan Canoe Paddle Canada Water Front Instructor Registration Form
Personal Information
Full Name*

First NameLast Name
E-mail*
Cell Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth
Weight *
Height*
Drysuit

I will rent a drysuitI have my own
Drysuit/Wetsuit Size

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Paddle Canada Membership Number
If you have a prior Paddle Canada Member #. If you do not remember you number if you can provide the email you would have used before with Paddle Canada we can look up.
Swimming Ability*
Medical and Emergency Contact Info for all Registrations
Medical Conditions*
Medical Information
Medications*
Medications Please list any and all
Emergency Contact person*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship
Course Selection Please Pick your courses here.
Professional Development Clinic

Dates to be determined
Water Front Instructor

May 5,6,7
Please detail your paddling skill experience and any instructing/coaching experience you have. *
Will you require a receipt and completion letter for Tourism Training Fund, Department of Education or other?*

YesNo
Online payment option If you would like to pay online use below section. 5% gst will be added to total. Please read our cancellation policy before booking your course. All participants will be required to sign both a Yukan Canoe and Paddle Canada waiver.
Additional Information
Should be Empty:

2023 Yukan Canoe Paddle Canada Water Front Instructor Registration Form