2025 Registration DISTANCE

2025 Distance KCC Paddler Registration

Before you start, you will need: digital photo of ID (Drivers License, State ID, etc.) and a headshot photo of yourself (similar to Passport photo). Uploads must be in one of the following formats: jpg, pdf, png, or gif.
YEAR*
Will the paddler be 15 years old on 8/1/25?*

YesNo
How did you hear about Kailua Canoe Club?*

FriendSchoolWebsiteSocial MediaBannersOther
Type*

ReturningNewTransfer
Is the paddler Native Hawaiian?

YesNo
Full Name of Paddler (First, Last)*
Paddler goes by name:*
Nickname, Hawaiian Name, etc.
Address*

Street Address

Apt or Unit #

CityState / Province

Postal / Zip Code
Email*

Confirmation EmailRe-enter email to confirm
Phone Number*
Please enter a valid phone number.
Gender*

MaleFemaleX
Birthdate*

MonthDayYear
Date
Age on 1/1/2025*
Occupation (or "Student")*
Ever paddle for Kailua Canoe Club or other canoe club in Hawaii?*

YesNo
If yes, please specify club(s)
Last year paddled
Division

YouthNov BNov AOpenMasters
If Nov B, did you race?

YesNo
If Nov A, how many years in this division?
Have you ever raced in any 6-man for (check all that apply)

School teamOut-of-State Club
Can you swim?*

YesNo
EMERGENCY CONTACT & MEDICAL INFORMATION
Emergency Contact 1*
Name
Phone*
Please enter a valid phone number.
Relationship*
Emergency Contact 2
Name
Phone
Please enter a valid phone number.
Relationship
Do you have any disabilities, medical conditions, or allergies that we need to be aware of?*

YesNo
If yes, please explain:
IN CASE OF EMERGENCY: It is the policy of Kailua Canoe Club to contact the family of the paddler regarding medical treatment if the paddler is injured or becomes ill. I give consent to have me/my child transported for treatment to the closest source of medical aid at the discretion of the coach or person in charge. I agree to assume all responsibility for medical and dental care of myself/my child/ward while I/they are involved in the activities of Kailua Canoe Club. I authorize the City and County of Honolulu Emergency units to administer appropriate treatment.
Adult Paddlers: Print Name*
PLEASE PRINT
Signature*

Clear
Today's Date*

MonthDayYear
Date
TO BE COMPLETED FOR ALL MINOR PADDLERS: I, Parent/Guardian Nameparent/guardian ofMinor's Name do hereby authorize my child/ward to participate in the canoe-racing season as a paid member of the Kailua Canoe Club.
Print Parent/Guardian Name
PLEASE PRINT
Parent/Guardian Signature

Clear
Today's Date

MonthDayYear
Date
UPLOAD PHOTO (pdf, jpg, jpeg, png, gif)*

Headshot Photo without Glasses or Hats
Cancelof
UPLOAD ID Driver's License, Military or State-issued ID, passport, birth certificate, etc.*

NOTE: Military IDs require photos from BOTH sides. Also, NO schoold IDs.
Cancelof
If you have questions about registration, email kccregistrar@gmail.com
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2025 Distance KCC Paddler Registration

EMERGENCY CONTACT & MEDICAL INFORMATION