Kid Active Registration Form

Please use this form to register for a summer KidActive session(s). A valid credit card is required to confirm your booking however, full payment for the course is due when you check in on the first day. Please complete a separate form for each child that you are registering. If yo would like to print off and download the application, please download and fax it into us here.

Please indicate the session(s) you are registering for:

 Session 1 July 4-8
Session 2 July 11-15
Session 3 July 18-22
Session 4 July 25-29
Session 5 Aug. 1-5
Session 6 Aug. 8-12
Session 7 Aug. 15-19
Session 8 Aug. 22-26
List any other participants your child would like to be in a group with:

Child’s Name*

Email*

Street Address*

City/Town*

Province*

Postal Code

Telephone - Day*

Telephone - Night*

Age*

Sex*

 Male
Female
Your Child’s Course Objectives and Paddling Experience
(if any)
Your Child’s Height & Weight*
(ensures a comfortable boat is available)
Medical Conditions/Allergies

Medications your child is taking or may take during the course.

Behavioural, social or any other situations you would like us to be aware of during the program.

Any additional information:

Credit Card Number*

Payment Type*

 Visa
Mastercard
Credit Card Expiry Month*

Credit Card Expiry Year*

Name on card:*

Is this registration sponsored?

 Yes
No
Subsidies are available. Please indicate if you are interested in a subsidized registration and briefly explain circumstances.

If yes, please provide sponsors name
(if known)
Subject

* Required field
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