TICC ORCKA BASIC 1-2, 3 and 4 Registration Form

ORCKA Basic 1-2, 3 and 4 Canoeing Registration Form
Registrant Details
Sat June 14 to Sunday June 15 (9:30a-2:30p both days)Sunday July 13 (8:15AM-6PM)
Basic 1-2 Sat June 6 8am -5pmBasic 1-2 Sun July5 8am-5pmBasic 3 Sun June 28 10am-3pmBasic 4 Solo July 11 and 12 10am-4pm both daysSolo Coaching Sunday June 7 10am-1pm
Full Name*

First NameLast Name
Date of Birth:*

DayMonthYear
month-day-year
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*

Confirmation Emailexample@example.com

Emergency Contact: *

Rows	Full Name	Contact Number	Relationship
1

OHIP Health Card Number*
include version code
yesno
Have been in a canoe once or twiceSome experience paddlingI have experience paddling in bow and stern
Yes I have ORCKA Basic Canoeing Level 3I will also sign up for ORCKA Basic Canoeing Level 3 on June 28 so that I can register for both courses now.
Do you have any health issues we should be aware of? If none, write NONE*

Rows Description

1
How did you hear about us?*
Please Specify*
ORCKA Required Waiver- read and check acknowledgement
I acknowledge that I have read and accept the conditions outlined in the above ORCKA Waiver.
Type your name here as signature
This Waiver has been witnessed by, please type your name here as signature
Refund Policy

We will refund your money in full should we cancel the course you registered for due to under registration, weather or other safety issues. If you choose to cancel your participation more than 14 + days in advance of the course date, we will refund you your payment less $25 for administrative fees. No refunds within two weeks of the course date.

Rows	Description
1

My Products*

ORCKA Basic Canoeing Tandem Levels 1-2 Saturday June 6 8am-5pm

$125.00CAD Quantity

ORCKA Basic Canoeing Tandem Levels 1-2 Sunday July 5 8am-5pm

$125.00CAD Quantity

ORCKA Basic Canoeing Tandem Level 3 Sunday June 28 10am-3pm

$100.00CAD Quantity
Item subtotal:$0.00CAD

ORCKA Basic Canoeing Intro to Solo Level 4 Sat July 11 -Sunday July 12 10am-4pm both days

$200.00CAD Quantity

Introduction to Solo Coaching Session (not a certifying course) Sunday June 7 10am-1pm

This coaching session is an introduction to solo canoeing but will not cover all aspects of a complete ORCKA Solo course.

$100.00CAD Quantity

Enter coupon

Total

$0.00CAD

ORCKA Basic 1-2, 3 and 4 Canoeing Registration Form