Paddler Challenge Registration Form

Paddler Challenge Registration Form

Please fill out this form to register for paddling activities at Eastside Paddlers.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email Address
example@example.com
Phone Number

Area CodePhone Number
Are you able to self transfer and close your airways if submerged? This is a minimum requirement for safety reasons.
There are steps with a rail to get down to the water where we operate at Oranga Hou. Would you be able to manage this?
Please describe the challenges/barriers that have previously held you back from trying kayaking
The club supply everything needed to get going on the water. How would we as coaches best help you?
Do you have any concerns about engaging in kayaking?
This form has been filled out by
Who should we contact to discuss how we can help?
Only complete the sections below if you are under 18, or you have indicated you would like us to speak with your parent/guardian/caregiver.
Parent/Guardian/caregiver name - Only required if you are under 18 or you have indicated you would like us to speak with them

First NameLast Name
Parent/Guardian/caregiver Phone Number

Area CodePhone Number
Relationship
Should be Empty: