Two-Week Camp & Paddle Ability

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2-Week Day Camp

Paddle Ability

For More Information on our Programs, Please Click HERE

Two-Week-Long Program

(choose week below)

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

My child is allowed off premises during the day

Yes

No

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

Yes

No

Select Item for payment

July 3-14 - C$550

July 17-28 - C$550

July 31-August 11 - C$550

August 14-25 - C$550

I have read and agree to theRefund Policy

I have read and agree to the terms of the WAIVER

PARENT EMAIL (required for communications)

Paddle Ability Program

Paddle Ability Program costs

$200

Paddler First Name

Paddler Last Name

Paddler Gender

Paddler Date of Birth

Paddler Health Card #

Select an option

New Paddler

Returning Paddler

Does the paddler have any restrictions in regards to intensity or type of activity they are participating in?

Can the paddler walk independently?

Can the Paddler Swim Independently?

Yes

No

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

Safety Considerations?

Any other considerations?

PARENT EMAIL (required for communications)

I agree to allow photos to be taken of the paddler for club promotion

Yes

No

Select Item for payment

Paddle Ability - C$200

I have read and agree to theRefund Policy

I have read and agree to the terms of the WAIVER

Contact

159 First Lake Drive

Lower Sackville, NS

B4C 3J9

Tel: 902-252-7225

info@sackawa.ca

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