info@purplehayes.bc.ca

Improve your river karma come join us on a river clean up!

Contact us for details

- Saturday, April 16th

- Sunday, September 25th

We are proud to support the Chilliwack Vedder River Cleanup Coalition.

Good Clean Fun Tee Shirts

$15.00 Contact us to order

 

 

 

Registration Form

Registration Form

Name *

First

Last
Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number

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###
-
####
Email *
Emergency contact name
Emergency contact number
Age
Height
required for gear sizing
Weight
required for gear sizing
Swimming ability
 Good  
 Fair 
 Poor 
Previous paddling experience
Expectations from this course
How did you hear about us?
Course Interest
 Pool Session 
 Give it a Whirl 
 Introductory Course 
 Advanced Beginner Clinic 
 Intermediate Clinic 
 Rolling Clinic 
 River Rescue for River Runners 
Course date

Medical Information

Allergies
 Bee stings 
 Penicillin 
 Pets 
Allergies other
General physical condition
 Good 
 Fair 
 Poor 
Chronic Disabilities
 Hearing 
 Sight 
 Other 
Please specify
Sight
 20/20 
 Glasses 
 Contacts 
Have you ever had any shoulder problems?
Please specify.
General questions or concerns you may have
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