Manitoba Paddling Association - Clinic Activity Consent Form

Activity Consent Form For Participation In MCKC Programs

Please take a moment to read the document below, then fill out the form in its entirety. This waiver is for those who wish to take part in MCKC programming.

Step 1: Participants Information

First name *

Last name *

Email *

Mobile *

Gender * Please specify

Date of birth *

Address *

City *

Country *

State/Province *

Region *

Zip/Postal code *

Parent or Guardian Information (if under 18 years of age)

First name

Last name

Date of birth

Relationship to participant

Clinic Group Name *

Please provide the name of the clinic you are attending. If you do not know, please contact your group leader for details (ALL CAPITALS).

Clinic Group Name

Paddling is a very safe activity, but there are inherent risks. The risks and means by which we reduce the risks are described below:

Common Risks

- Sunburn
- Blisters
- Muscle strain - Insect bites

Rare Risks

- Bruises/fractures due to falls - Cuts/dental injury/concussion - Heat stroke/dehydration
- Hypothermia

Extremely Rare

- Worsening of pre-existing medical condition or allergy

Death or severe injury from:
- Drowning/near drowning
- Lightning strike or injury arising from severe weather

I read and accept these risks *

Please read and scroll to the bottom to accept.

Step 4: Electronic signature*

Please use your mouse or finger to sign your name in the box below

Type your name

Signature style

Step 4: Electronic signature Signature pad

A required field has not been filled.

Please accept all conditions.

Connect to fill this form

Please type in your email or mobile number. We will send you a connection code.

Email or mobile

Connection code

Waitlist

Leave us your coordinates. We will contact you when a spot frees up.

Comment

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Membership

Your membership is tied to your email address. If you are using the wrong email, your membership will not be detected. You can try disconnecting and connecting using another email address.

If you need further assistance, please write to info@activitymessenger.com. Please include a screen capture if possible.