Course Registration Form.

Name
Phone
Address
Email
City & Postal Code
Age (if under 19)

Course Content (please circle the levels)

Lakewater

Basic Tandem

Basic Solo

Advanced Tandem Advanced Solo Instructor
Ocean     Basic Advanced Instructor
Moving Water  

 

3 (Tandem) 4 (Solo) Instructor
Other: (specify)

 

 

Date

Location

Instructed by:  Carey Robson

 

Do you have any physical impairments?

no

yes

Canoeing Experience: none less than 1 year 1year 2 or more years

Canoeing Certificates held:

  Level Year Issued by
Paddler      
       
Instructor      
       
Equipment: Do you have the following available in good condition? Canoe Paddle P.F.D. (lifejacket)
Are you able to swim 50 metres fully clothed? yes no
If not, are you comfortable in deep water while wearing a P.F.D.? yes no

 

Signature of applicant(s)
Date
Signature of Parent or guardian (if applicant is under 19 years of age)

Waiver and Release of Liability

In consideration of being allowed to participate in any way in the Recreational Canoeing Association of British Columbia (RCABC), or its member clubs’, instructor’s courses, paddling programs, activities, events and trips, the undersigned acknowledges, appreciates and agrees that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death; and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist: and,

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, or others, and assume full responsibility for my participation; and,

I willingly agree to comply with the stated and customary terms and conditions for participation. If however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Recreational Canoeing Association of British Columbia, its member instructor’s, their officers, officials, volunteers, agents and /or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (all of whom or referred to as "Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, whether caused by the negligence of the releasees or otherwise.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHT BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Participant’s
Signature:

Witness
Date

For participants of minority age (under 19 at time of registration).

This is to certify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above.

Parent/Guardian Emergency Phone
Witness
Date

 

Mail to:

Carey Robson
4782 Fernglen Dr.
Burnaby, BC  V5G 3V7

Email signed PDF to:

Carey@CanoeBC.ca