First Name**

Last Name**
E-Mail**

Phone Number **
Address 1**
City** Prov / State**
Postal Code / Zip Code**

Emergency Contact Person**

Contact PhoneNumber**

Course Date & Name

Shortts Lake Clinic July 3 Into to Kayaking Instructor NS August 27-29 Flat Water Skills June 26 Halifax Flat Water Skills July 3 Fredericton Flat Water Skills July 24 Truro Flat Water Skills August 1 Halifax Flat Water Skills August 7 Saint John Flat Water Skills August 14 Saint John Flat Water Skills August 22 Saint John Level 1 Skills Yarmouth July 10-11 Level 1 Skills July 17-18 Saint John Level 1 Skills July 31- August 1 New Glasgow Level 1 Skills July 31- August 1 Saint John Paddle Canada Level 2 Deer Island, NB July 15-19 Private Instruction (One on One) Tidal Day Date: TBA CKNS JUNE 28 Clinic CKNS July26 Clinic DFO Training July 30 Intro Kayak Skills August 7 Tumblehome Paddlers Intro Kayak Skills August 8 Tumblehome Paddlers

Kayaking Experience


Special Dietary requirements / requests

Will you need extra gear for the course ?


Make and Model of Kayak?

Reason for taking the course?

Are you under supervision of a doctor at present

If YES please provide details below, be as detailed as possible.

Do you have any limitations that will come into play while on the course?