Term 1 2024 North Shore Canoe Club Try Learn Explore Intro Course

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Thank you for registering for one of the North Shore Canoe Club Try Learn Explore Intro Courses

Please fill out the following form to complete your registration.
If you are under 18 you must complete the parent consent form that will be emailed to you after registration.

For any additional queries please email us at info@northshorecanoeclub.org.nz

Email *

First Name *

Surname *

Date of Birth *

YYYY

Email Address *

Mobile Number *

Gender *

Ethnicity - Please comment below with which ethnicities you identify (e.g NZ European / Māori / Chinese / Pasifika / Indian etc.) Please feel free to include more than one if relevant. *

Important Medical Information
Please state below details about any disability you have, any important medical or surgical history, any medicines taken regularly and any known allergies. *

Emergency Contact Name *

Emergency Contact Mobile Number *

Can you swim 50m wearing a buoyancy aid? *

Yes

Parent / Guardian Name (Required for Under 18 only)

Parent / Guardian Email (Required for Under 18 only)

Parent / Guardian Mobile Number (Required for Under 18 only)

Where did you hear about North Shore Canoe Club and our Try Learn Explore Courses? *

Submit

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