Canoe Camp Application Form

Paddler Information

Today's Date (dd-mm-yyyy) *

Name *

First

Last

Date Of Birth (dd-mm-yyyy) *

Sex *

female male

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number (primary) *

Phone Number (secondary) *

Which of our camps are you interested in attending? *

Maui Downwind Camp February 22-26, 2012 Maui Women's Only Downwind Camp, April 6-10, 2012 Maui to Molokai Race Prep Camp, April 23-28, 2012

Do you have any medical conditions that we should be aware of? *

How long have you been involved in paddling outrigger/surfski *

What major events have you participated in recently? (last 2 years) *

Please briefly describe your current weekly workout schedule (number, type, duration of workouts) *

Are you able to swim 500 meters? *

Yes No

Are you able to tread water for 30 minutes? *

yes no

Unisex Shirt Size *

Name *

First

Last

Relationship *

Phone Number (primary) *

Phone Number (secondary) *

Submit