Learn to Canoe Registration Form  
 
First name:
Surname:
Age:
Occupation:
Cell no.:
Email Address:
Study Course:
Year:
Name of School:
Grade:
Family Contact Name & Tel no.:
Program Fee  
R250.00 per person  
Family Package:  
1 Family member - R220.00 e.a  
2 Family member - R185.00 e.a  
3 - 4 Members - R155.00 e.a  
Medical History  
Complete Yes or No:  
Do you suffer from:  
1. Epilepsy?
2. Diabetes?
3. Asthma?
4. Bee stings?
Have you had any previous drowing experiences?
Have you had any neck, head or back injury or operation?
Have you sustained a fracture or dislocation in the past 2 years?
Are you currently on prescribed medication?
Idemnity
1. Each person accepts the risk and responsibility to participate in the programme as their own.
2. Participants waives the right to claim for damages, loss, injury or death that may be sustained during the duration of the programme and or there after.
3. The programme management, Club, University and or its staff assumes no responsibility of cost involved with the individual bodily injury or damage to property or loss incurred in connection with the use of the facilities and equipment.
4. It is recommended that applicants who have a medical history, to have a complete physical check-up before engaging in the programme.
 
     
 
 
Username:
(email address)
Password:
(membership number)
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