Contact information

First name

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Last name

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Phone

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Phone type
Email address

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Address

Address

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Apartment, suite, etc. (optional)
City

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Country/region

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State

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ZIP code

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Additional details

To help the Skowhegan Outdoors staff provide participants with the best experience possible, please complete the following questionnaire.  Please keep in mind that for safety reasons, each participants must know how to swim.

Contact phone number for person completing the questionnaire (XXX-XXX-XXXX).

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Participant Date of Birth (MM-DD-YYYY)

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Emergency Contact Info #1 (please include first, last name and contact phone number)

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Emergency Contact Info #2 (please include first, last name and contact phone number)

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Please list all known allergies (food allergies, asthma, bee stings etc). If none, please respond none.

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Has the particpant previously participated in whitewater kayaking clinics or whitewater instruction? If yes, please specify.

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Does the camper know how to swim?

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Should we know anything else?

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Registration fee

A registration fee is required to participate

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Payment

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Card number
Cardholder name

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Email address

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Account holder name

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Email address

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Billing address

Address

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Apartment, suite, etc. (optional)
City

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Country/region

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State

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ZIP code

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Confirmation

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