Canoe Education Weekend Enrolment Form

 

       Canoe Education Weekend

        Derwent River – New Norfolk and Plenty Rapid

        March 25/26

 

 

Flatwater and Whitewater

 – Instruction in Paddling Skills and Safety

 – Instructor courses

 

Who is this weekend for? This weekend is for people:

 

v Wanting to learn how to paddle a kayak or canoe on flatwater or whitewater

v Wishing to be assessed for Australian Canoeing paddling skills awards

v Wanting to become AC qualified instructors on flat water (Level 1) or white water (Level 2)

v Who are instructors wishing to re-ratify

 

Instruction in Paddling Skills and Safety

Do you want to learn how to paddle that kayak you got for Christmas?

Do you want to start paddling in whitewater?

Qualified instructors will work with small groups of paddlers of similar experience and ability, on both flatwater and whitewater. Novices through to paddlers with some whitewater experience are catered for. Paddlers will have the opportunity to be assessed for a range of AC paddling skill awards on Sunday afternoon.

 

 

Instructor courses

Do you wish to start an Australian Canoeing Instructor Award on flatwater or whitewater?
Do you want to complete your instructor award?

Does your instructor award need to be re-ratified?

Experienced trainers will provide information on what is needed to achieve the AC instructor awards, and help paddlers start that process. Assessors will help paddlers to complete their instructor training and assessment process for the paddling specific units.

Information on reratification, and assistance with the process will be provided.

 

 

Program

The weekend will commence at 10am Saturday, March 25, at New Norfolk, and conclude at 3pm on Sunday, March 26.

Instructional groups for the weekend will be organised at this time by their instructors. Each group will work at suitable venues according to their needs, and according to their own timetable. More details will be provided with confirmation of enrolment.

 

Enrolment

To enrol, complete the enrolment, indemnity and medical questionnaire forms and return with full payment, by the due date, to:

Andrea McQuitty

Canoe Tasmania

4 Beach St

Leith   7315

Please note that payment is by cheque or money order made payable to Canoe Tasmania Inc. only.

Contact Andrea to organise any alternative payment arrangements if necessary.

 

     Enrolments close on Friday, March 17

 

 

 

 

For more information, contact:   Andrea McQuitty (03) 6428 2270 – mcdeka@southcom.com.au

 

                                               

 

 

 

 

      

    Enrolment Form   Canoe Education Weekend   March 25/26, 2006

 

   

 

 

Name:………………………………………………………………………………… D.O.B:………………………………

Address:……………………………………………………………………………. Suburb:……………………………. P/Code:………………

Phone:…………………………(H)…………………………….(W)……………………………………(M)…………………………………………..

Email:……………………………………………………….

 

Emergency contact name and phone number:……………………………………………………………………………………………………………..

 

 

Previous paddling experience (include places paddled and craft used)……………………………………………………………………….

………………………………………………………………………………………………………………………………………………………………………………………..

 

 

Please tick the box for which course you are interested in attending.

 

 Skills Courses                                                                 Cost                                                                                      

 

Flat water / inland skills – no assessment

$65

 

Flat water / inland skills + Basic Skills Award assessment (non VET)

$75

 

Flat water / inland skills + AC Flat water/Inland Award assessment

$85

 

 

 

 

White water skills – no assessment

$80

 

White water skills + AC White water Skills Award assessment

$100

 

 

 

 

Assessment only, for any AC Skill Award (please specify)

$40

 

 

 

 

Instructional Courses

 

 

AC Flat water / Inland Instructor (Level 1) commencing

$250

 

AC White water Instructor (Level 2) commencing

$260

 

AC Flat water / Inland Instructor (Level 1) Completing course started in Oct 2005

No charge

 

AC White water Instructor (Level 2) Completing Course started in Oct 2005

No Charge

 

Re-ratifying Instructor

$20


TOTAL PAYMENT ENCLOSED:…………………

 

Please note:

Instructors need to pay an additional $140 to Australian Canoeing upon completion of their accreditation to cover insurance for three (3) years.

 

Payment by cheque or money order to: Canoe Tasmania Inc.

Contact Andrea for alternative payment options if necessary

 

 

 

 

ENROLMENTS CLOSE FRIDAY, MARCH 17

 

 

o                   I have signed the Indemnity and Medical forms attached.

o                   Return to: Andrea McQuitty

                               4 Beach St

                               Leith 7315

 

 

 

 

 

 

 

 

 

 

MEDICAL QUESTIONNAIRE &

CONSENT FORM

Please complete the following by circling the relevant answer.

 

 

1. Do you suffer from any medical condition, illness, injury or disability that may interfere with or be aggravated     

     by the proposed activity?     YES / NO

 

If YES, please give details …………………………………………………………………………………………………………………………………………………

 

2. Is the abovementioned condition likely to require any special attention, treatment or medication during the

     activity?        YES / NO

 

If YES, please give details (including nature and availability)…………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………………………….……

 

3. Have you ever had a serious allergic reaction to an insect, animal or plant?   YES / NO

 

If YES, please give details (including reaction & treatment)

……………………………………………………………………………………………………………………………………………………………………………………………

 

4. Can you swim the length of an Olympic Swimming pool?     YES / NO

 

If NO, please give details………………………………………………………………………………………………………………………………………………….

 

 

 

CONSENT FOR EMERGENCY TRANSPORT &/OR MEDICAL ATTENTION

 

I,                  ……………………………………………… (full name) of   ……………………………..……………………..( address )

hereby give consent to being transported by Ambulance or other appropriate transport to the nearest medical centre or hospital for emergency or life preserving treatment by an appropriately qualified medical person.

It is understood that such treatment would be at my expense.

 

Signed:  ……………………………………………………. Dated this …………………. day of ……………………… 2005

 

Signed by parent if applicant is under 18 years   ……………………………………………………

 

 

INDEMNITY AGREEMENT & WAIVER of LIABILITY

 

Teaching, Training & Assessment Events – Canoe Tasmania Canoe Education

 

Participant’s name: …………………………………………………………………………….

 

I / we hereby acknowledge and understand that I / my son / my daughter / my dependant will be participating in a Canoe Tasmania Canoe Education event, and that I fully understand the nature of the activity to be undertaken after having read and understood any printed material supplied to me and after making enquiries to my satisfaction.

 

In consideration of the Canoe Tasmania Canoe Education as a subcommittee of Canoe Tasmania Inc. providing this activity for me / my daughter / my son / my dependant I hereby acknowledge that  Canoe Tasmania Canoe Education, Canoe Tasmania Inc. and Australian Canoeing Inc., their Instructors, employees, officers, servants and agents shall not be liable for any injury, damage, loss, claim or demand whatsoever which may arise during, or in association with, participation in or travelling to or from the activity unless the same is caused by negligence or a criminal act on the part of the said Canoe Tasmania Canoe Education, Canoe Tasmania Inc. or Australian Canoeing Inc., their Instructors, employees, officers, servants and agents and I / we hereby agree to indemnify and keep indemnified the said Canoe Tasmania Canoe Education, Canoe Tasmania Inc, Australian Canoeing Inc., their Instructors, employees, officers, servants and agents against all actions, suits, damage claims and demands arising out of any accident, loss or illness which may befall me / my son / my daughter / my dependant during or as a result of my / his / her participation In any activity or function connected with the event or whilst travelling to or from the said event unless the same is caused by negligence or a criminal act on the part of the said Canoe Tasmania Canoe Education, Canoe Tasmania Inc. or Australian Canoeing Inc., their Instructors, employees, officers, servants and agents.

 

<P class=Mso