Name:
Age?
Email Address:
Phone number
Can You Swim?	Yes No
Have You ever been in a kayak	Yes No
Have You Ever Paddled A kayak?	Yes No
Can you Roll Check all that apply	Most times In the pool On the river
What do you paddle? Check all that apply	Flat Water White Water In the pool Ocean
What Class are you taking	Flat water clinic White water clinic
What Yype of Boat do you paddle	Rec Boat Sea Kayak Whate Water Kayak Ducky
Do You have any Physical or medical problems that we should know about? No nned to list just let us know at the clinic	Yes No
Are You just Volunterring to help out	Yes you betcha No I need the class

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