CanoeEd October Forth Rego Form 2015

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Canoe Education
Canoe Education Weekend
Oct 17th – 18th, 2015, Forth River (North)
Canoe Tasmania will conduct the following courses at the Canoe Education Weekend at Forth.
Please select the course that you wish to attend (Registrations Close 9TH October):
Basic Skills and Safety
Cost: $25 ($20 for affiliated canoe club members)
Saturday Oct 17th, 9.30am – 11.30am
Turners Beach boat ramp
Essential skills for safe paddling, suitable for beginner to intermediate paddlers, any type of kayak, to be held on
the Forth estuary. Participants must have their own kayak and PFD (life jacket).
Sea Kayaking Skills
Cost: $45 ($35 for affiliated canoe club members)
Saturday Oct 17th, 12.30pm – 4:00pm Turners Beach boat ramp
Intermediate skills for sea kayak paddlers – surf launching and landings, paddling skills, rescues.
Participants must have their own sea kayak.
Whitewater Skills - Saturday
Cost: $95 ($80 for affiliated canoe club members)
Saturday Oct 17th, 9:30am – 4pm
Forth Canoe Course
Whitewater Skills – one day course developing whitewater paddling skills on Grade 2-3 water.
Small group instruction from some of Tasmania’s best whitewater paddlers and qualified AC instructors.
Whitewater Skills - Sunday
Cost: $95 ($80 for affiliated canoe club members)
Sunday, Oct 18th, 9:30am – 4pm Forth Canoe Course
Whitewater Skills – one day course developing whitewater paddling skills on Grade 2-3 water.
Small group instruction from some of Tasmania’s best whitewater paddlers and qualified AC instructors.
Flatwater Guide/Lifeguard/Instructor Course Cost: $265
(plus $155 AC registration fee
if seeking assessment for Guide/Instructor and successful)
Saturday - Sunday, Oct 17th – Sun 18th, 9am – 4 pm
Australian Canoeing accredited course for teaching
skills and leading trips on flat water. Assessment options for: Flatwater Lifeguard, FW Guide or Instructor
available.
Whitewater Guide/Instructor Training Course
Cost: $265
Saturday - Sunday, Oct 17th – Sun 18th, 9am – 4 pm
Forth Canoe Course
Australian Canoeing training course for teaching skills and leading trips on moving water up to, and including,
Grade 2 for experienced paddlers. This training course is a strongly recommended pre-requisite for anyone
wanting to go for the Australian Canoeing Whitewater Instructor Assessment at a future date (1.5 days
assessment, separate). This is not an introduction to Whitewater Skills course (see above 1 day courses for Skills
development), but for experienced paddlers looking at demonstrating correct stroke technique in an instructing
situation on moving water, breaking down and teaching stroke technique, whitewater rescue techniques and the
requirements for Whitewater Guide/Instructor Assessment.
Whitewater Guide/Instructor Assessment
Cost: $110
(plus $155 AC registration fee)
Oct 17th – 18th, Starting 9am Saturday (1.5 days, finishing lunchtime Sunday). Forth Canoe Course
Assessment for the Australian Canoeing Award of either Guide or Instructor for guiding/teaching skills and leading
trips on moving water up to, and including, Grade 2.
Students Whitewater Skills Course
(TBC)
Cost: $25
Saturday - Sunday, Oct 17th – 18th, Forth Canoe Course
Times by arrangement
Two hour, whitewater skills sessions for students run by trainee whitewater instructors working under the
supervision of AC qualified whitewater instructors and assessors. Note this only runs if there are enough
participants going for an assessed qualification for WWG or WWI – contact Development Officer to confirm details.
Camping at Forth Canoe Course
Cost: $5/night
Enrolment Form
Name:
Address:
Email:
Phone:
Emergency
Contact: Name & No
Age if under 18:
Paddling/Instructing Experience (outline any previous kayaking/canoeing activities and experience
you have):
Payment Options (to be made prior to the course):
Cheque/Postal Order
Make payable to: Canoe Tasmania
Post to:
Direct Deposit
Include your name as
reference.
Return Registration Form to:
Canoe Tasmania
GPO Box 25
Hobart, Tas 7001
Canoe Tasmania Inc.
MyState Financial
BSB: 807009
Acc No: 12245398
Canoe Tasmania
GPO Box 25
Hobart, Tas 7001
Total Amount Paid: $
Include transaction receipt
Email: [email protected]
Medical Questionnaire & Consent
Do you suffer from any medical condition, illness, injury or disability that may interfere with or be
aggravated by the proposed activity? If yes, details:
YES / NO
Is the abovementioned condition likely to require any special attention, treatment or medication
during the activity?
If yes, details:
YES / NO
Have you ever had a serious allergic reaction to an insect, animal or plant? If yes, details (including
reaction & treatment):
YES / NO
Can you swim the length of an Olympic Swimming pool?
YES / NO
Indemnity Agreement & Waiver of Liability Teaching, Training & Assessment Events
Participants Name:
Age if under 18:
I / we hereby acknowledge and understand that I / my son / my daughter / my dependent 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 Inc. providing this activity for me / my daughter / my son / my dependent I hereby
acknowledge that 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 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 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 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 Canoe Tasmania Inc. or Australian Canoeing Inc., their Instructors,
employees, officers, servants and agents.
Signed By:
Name (printed):
Date:
(To be signed by Parent or Guardian if participant under 18 years of age)
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.
Signed (parent/guardian if under 18):
Name:
Date:
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