2023 Small Waves Strong Minds Program Registration
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Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent E-Mail *
Parent/Guardian Phone Number *
How did you hear about this program? *
PARTICIPANT PICKUP INFORMATION
Photo identification of the caregiver picking up your child will be cross-referenced before your child is picked up
What is the first and last name of the caregiver who will be picking up and dropping off your child? *
What is the phone number of the caregiver who will be picking up and dropping off your child? *
PARTICIPANT INFORMATION
Participants First Name: *
Participants Last Name: *
Participants Date of Birth: *
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Age of participant: *
Gender: *
Please indicate any paddling experience (no paddling experience is required).
Please indicate swimming ability (most recent swimming certification):
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Swimming Ability: If "Other" Please Provide (Certifying Body and Level)
Please list any of the participants allergies:
Is the participant on any medications? Please list the medication and frequency:
Does the participant have any past medical history we should be aware of? Or any risk factors we should be aware of?
PROGRAM REGISTRATION
Billing Address (Number Street, City, Province, Postal Code) *
KAYAK & STAND UP PADDLE BOARD:  ($240/session, taxes included).
Yes
KayakSUP 1: July 3,5,7
KayakSUP 2: July 10,12,14 (FULL)
KayakSUP 3: July 17,19,21 (FULL)
KayakSUP 4: July 24,26,28
KayakSUP 5: July 31, August 2,4
KayakSUP 6: August 9,11 ($154)
KayakSUP 7: August 14,16,18 (FULL)
KayakSUP 8: August 21,23,25
KayakSUP 9: August 28,30, Sept 1
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OUTRIGGER CANOE & FITNESS/MOVEMENT ($170/session taxes included)
Yes
CanoeDB1: July 2, 4
CanoeDB2: July 9, 11
CanoeDB3: July 16,18
CanoeDB4: July 23, 25
CanoeDB5: July 30, August 1
CanoeDB6: August 6, 8
CanoeDB7: August 13, 15
CanoeDB8: August 20, 22
CanoeDB9: August 27, 29
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Payment through Email Money Transfer (EMT): Please send your EMT payment to: "payments@sunnysidepc.ca" along with your childs name and week registered (all prices already include tax). A receipt and email confirmation will be provided once payment is received.   Full refunds will be given back within 30 days of registration. If we are unable to reschedule a cancelled session a refund will be given for that session minus a $3 administrative fee. Refunds will also be given back if the session is cancelled due to no part of your own or Ontario Public Health Regulations.
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