Medical Form * = Required FieldName* First Last Address* Mailing Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Preferred Phone*Birth Date* Date Format: MM slash DD slash YYYY PHN (Health #)*Dr. NameDr. PhoneEmergency Contact*Emergency Phone*All participants must be double vaccinated for COVID-19 in order to participate in the 2022 paddling season. Vaccination passports and Government issued photo identification must be provided prior to your first practice. I am double vaccinated for COVID-19:*YesNoHealth conditions (includes allergies, medications and any diagnoses).*Medications carried on you*Swim Level*Non-swimmerBasicIntermediateAdvancedAny current, formal medical trainingConsent* I hereby authorize the person/persons in charge to secure such medical advice and services deemed necessary for my health and safety. I will advise the Club of any changes in my medical condition.Date* Date Format: MM slash DD slash YYYY CAPTCHA This form will be brought on the boat during every practice and festival. 2022Mar12 - Medical Form