2020 Yorkton Canoe Kayak Club Membership Application

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Please use this online form for all programs (Dragon Boat, CanoeKids, Racing Program, General Membership). EACH MEMBER ON DRAGON BOAT TEAMS NEEDS TO FILL OUT REGISTRATION FORM.

Thank you for your patience when completing this form. Due to the nature of 2020 and some of the challenges we are facing, we had to add new sections to this form. To make sure you are in the right sections, you may have to answer a question more than once.

You will be contacted if there is any issues with this Application for Membership.

If you do not have an email address, please enter yckcguest@gmail.com.

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E-pošta *

Today's Date *

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Member/Participant's First Name *

Member/Participant's Last Name *

Member/Participant's Email (if different than who is registering)

Would you like to be notified via email about YCKC programs and upcoming events? *

Yes - Please confirm you have given a valid email above

Address *

City *

Province *

Postal Code *

Member/Participant's Primary Phone Number *

Secondary Phone Number (optional)

Member/Participant's Date of Birth (Please double check the year) *

GGGG

Self Designation (Optional)

Status/Treaty

Non-Status

Metis

Inuit

Očisti odabir

Emergency Contact (Name and Phone number) *

Medical Limitations/concerns, medications, or allergies. (This information is confidential and will only be used to help our coaches provide a safe and adaptive environment for all participants) *

N/A - I am able to fully participate in physical activity

Would prefer to discuss with coach in person

Allergies (Please complete next question)

Have had surgery which may affect ability to participate fully (Please complete next question)

Pregnant

Heart/ Cardiovascular Conditions

Visual Impairment (Please specify in next question how we can accommodate your needs)

Hearing Impairment (Please specify in next question how we can accommodate your needs)

Cognitive limitations (Please specify in next question how we can accommodate your needs)

Other Medial Limitations/concerns (Please complete next question)

I am not willing to disclose this information at this time

Ostalo:

Obavezno

Important Medical details:

Do you give permission for YCKC to use your photo for promotional purposes. This may include: Video productions, website, Facebook, posters, brochures, etc. Names will NOT be used without further permission *

Yes

Would you like to purchase a YCKC T-shirt for $12?

Yes

Očisti odabir

T-shirt sizing (if applicable)

The participant is.... *

Under 18 years of age

Over 18 years of age

Dalje

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