SCHEDULE

Canoe
Kayak&Tube

Area Info.
 

ACA Instruction

Contact us

About the Creek:  
   Creek Maps
        lower
        Upper

Trip Details

Livery Detail $$$

What to bring
    

Reality Check
   Waivers

  MED Forms  
 
WW Outfit

Weather Stuff

Gauges/Levels

Reservations

Refunds &
Payment

Area Info.
    Directions
    Place Stay
    Place eat
    Thing to do
    Creek GPS

 

 

CKAPCO / Antietam Creek, Greg Mallet-Prevost
Class/trip Registration and Information Form
 

1. Class/trip description and Date(s)_______________________________

Name ____________________________________ Date of Birth ___________________

Address ______________________________________________________________________

Street City State ZIP

Telephone number(s) ____________________________________________________________

Home Work Other

E-mail addresses) ______________________________________________________________ Home Work

 

    Background

I am taking this course because____________________________________________

 

Briefly describe your paddling experience: _____________________________________________

____________________________________________________________________________

          Approximate height and weight _____________________________________

          ____________________________________________________________________________

           

          Please rate your swimming ability: none weak good strong

           

    Confidential Medical and Emergency Information

Emergency contact ___________________________________________________

Name

____________________________________________________________________________

Telephone Number Relationship to you

Please list any medications you are taking: _____________________________________________

Do you have any medical conditions we need to know in case of emergency? ____________________

If so, please explain: _____________________________________________________________

Please indicate any medical or environmental allergies: ____________________________________

Do you have any physical limitations that could affect your participation in the course? ______________

If so, please explain: _____________________________________________________________

Signature and date please.

 

 



Home Page   Canoe   Kayak    Area Information   Reservation   [top of this page]  

GMP/T&E SYS INK.
Copyright 1997 [antietamcreek.com]. All rights reserved.
Revised: August 22, 2014.