SCC Trip Registration Form
BROKE INLET JANUARY 2025
Run by Marty - questions to landass@iinet.net.au or on 0417 900 724
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First and Last Name
*
Mobile Phone Number
*
Format: 0000 000 000.
Email Address
*
example@example.com
Emergency Contact Name
*
First and Last Name
Emergency Contact Mobile Phone Number
*
Format: 0000 000 000.
Your vehicle details or name of person you are travelling with
*
Do you have capacity to take another boat and passenger in your car?
*
Yes
No
Are you taking a club boat or your own boat?
*
Club boat
Own boat
Paddler Skill Level
*
Beginner
Intermediate
Advanced
Please list any medical information or physical limitations that are appropriate for the guide/instructor to be aware of
*
WARNING: Kayaking can be inherently dangerous. Serious accidents can happen which may result in injury or even death. RELEASE OF ACCEPTANCE OF RISK: Except where provided or required by law and such cannot be excluded, I am aware that there may be risks associated with kayaking and I do accept these risks and will hold Swan Canoe Club and its instructors free from liability, actions, causes of actions and demands for loss or injury to myself or my dependants. The terms hereof shall serve as a release and acceptance of risk for myself family and heirs. I have voluntarily read and understood this warning and accept and assume the inherent risks in kayaking.
*
Submit
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