Intermediate Whitewater Packrafting Course Registration

Participants Name (required)

Participants Address (required)

Date of birth: dd/mm/yyyy (required)

Email contact (required)

Phone (required)

Emergency Contact: Name

Emergency Contact No (required)

Previous Experience

How comfortable are you with self-rescues in a packaft in whitewater?

Do you have your own packraft? YesNo

If bringing your own it helps instructors to know what type of packraft you are paddling.

Details: (deck/thigh straps/model/etc)

Do you intend to hire?YesNo

If you intend to hire then you MUST CONTACT the organiser at mark.oates.outdoors@gmail.com.au to arrange this.

Equipment: Participants will need to provide and bring a packraft, paddle, PFD, kayak helmet & all personal paddling clothing. Participants who don’t have suitable equipment for whitewater are encouraged to hire gear until after completing the course where they will have a much better idea of equipment options and their pros/cons. If you wish to hire a packraft (self-bailing available) with paddling gear the cost is $40 per day and you will need to do this by contacting Mark Oates directly via mark.oates.outdoors@gmail.com
Note that the hire of these items is not through Paddle Tasmania and needs to be arranged independently.

Medical Questionnaire and Consent (required)

Do you suffer from any medical condition illness injury or disability that may interfere with or be aggravated by the proposed activity?

If yes please provide details

Is the above mentioned condition likely to require any special attention, treatment or medication
during the activity? (required)

If yes please provide details

Have you ever had a serious allergic reaction to an insect, animal or plant? (required)

If yes please provide details (including reaction & treatment):

Can you swim 25 metres?

Indemnity Agreement & Waiver of Liability Teaching, Training & Assessment Events :

Participants Name:(required)

Age if under 18:

I/we hereby acknowledge and understand that I / my son / my daughter / my dependent mentioned above will be participating in a Paddle Tasmania Paddle 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 Paddle Tasmania (formerly Canoe Tasmania Inc.) providing this activity for me / my daughter / my son / my dependent I
hereby acknowledge that Paddle Tasmania and Paddle Australia, 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 Paddle Tasmania or Paddle Australian, their
Instructors, employees, officers, servants and agents and I / we hereby agree to indemnify and keep indemnified
the said Paddle Tasmania or Paddle Australian, 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 dependent 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 Paddle Tasmania or Paddle Australian, their Instructors, employees, officers, servants and agents. If you agree please check box.YesNo

Consent For Emergency Transport &/Or Medical Attention (required): I hereby give consent for me/my daughter/my son/my dependent, mentioned above 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. If you agree please check box. YesNo

Your Name Date: dd/mm/yyyy

Payment: (to be made prior to commencement)

Direct Deposit. (Please use “Surname WWPR Inter” as the reference.)
Canoe Tasmania Inc.
MyState Financial
BSB: 807009
Acc No: 12245398

COURSE COST: $295

Total Amount Paid: $

Transaction Receipt Number:

Cancelation Fees apply: cancellation 21 days or more prior to course full refund
20-14 days prior to course 10% of course fee
13-2 days prior to course 15% of course fee
less than 48 hours no refund.

Any further information

If you experience problems forwarding this form please email canoe.tas@canoe.org.au