2023 Spring Paddling Registration

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2023 After-School
Spring paddling

Paddler First Name

Paddler Last Name

Paddler Gender

Paddler Date of Birth

Paddler Health Card #

Select an option *

New Paddler

Returning Paddler

Paddler Medical Conditions

Paddler Allergies

Medications required for Paddler

Storage of Medications

Anaphylaxis?

Epipen?

Yes

No

Emergency Contact #1 Name

Emergency Contact #1 Phone number

Emergency Contact #2 Name

Emergency Contact #2 Phone number

Mother Name:

Mother Phone Number

Father name

Father Phone Number

#1 Authorized to Pick-up

#2 Authorized to Pick-up

#3 Authorized to Pick-up

My Child is authorized to walk home *

Yes

No

I agree to allow photos to be taken of my child for club promotion *

Yes

No

Select an item (C$) *

May After-School Paddling Program - C$155

June May After-School Paddling Program - C$155

May and June After-School Paddling Program - C$300

I have read and agree to theRefund Policy

I have read and agree to the terms of the WAIVER

PARENT EMAIL (required for communications)

Contact

159 First Lake Drive

Lower Sackville, NS

B4C 3J9

Tel: 902-252-7225

info@sackawa.ca

Enter Your Name

Enter Your Email

Enter Your Subject

Message

Thanks for submitting!

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2023 After-School Spring paddling

2023 After-School
Spring paddling