Registration Form

Full Name  
Address

 

Postcode:                  
Telephone (H) (W)
Mobile  
Email  
Emergency Contact Name  

Emergency Contact Numbers

  
Have you any Medical Condtions? (specify)

 
Can you swim 50m? Yes       No      
Course Selected  
Date(s)  
Craft Own       Hire      
Previous Experience Flatwater:
Whitewater:
Payment $                         (inc GST)

$                      (inc GST & Hire)

Name on Credit Card:

 Type:   Visa Mastercard Bankcard
Number: Expiry:

Booking deadlines 1 week prior to course date.

Cheques payable to:
Canoeing Down Under
144 Railway Pde, Bassendean, 6054


Release of Acceptance of Risk

I am aware that there may be risks associated with canoeing and kayaking, flat and whitewater. I do accept all those risks and will hold 'Canoeing Down Under' and its instructors free from liability, actions, causes of actions and demands for loss or injury to myself or my dependants. The terms hereof shall serve as a release and acceptance of risk for my heirs, executors, administrators and assigns for all members of my family.

Signed:

Date:
Parent or legal guardian must sign for persons under 18 years of age