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Trip/Course/Workshop Registration Form

Just fill in the form below to apply for a trip, course or workshop. We will contact you shortly to confirm that your space is reserved. We will e-mail confirmation and a pre-trip package to you right away.

First Name:

Last Name:

Street Address:

Suite #:

PO Box:

City:

Province/State:

Postal/Zip Code:

Country:

Phone (Day):

Phone (Evening):

Email:

Program Name:

Dates:

How did you hear about us?

Brochure

Mag Advert

Web Search

Mag Article

Paddling Ontario Website

Slide show

Other Website

Web advert

Word of Mouth

Other

Previous Guest

Please be as specific as possible:

What interested you in this trip/course?

Your occupation:

Boat Required:

Yes

No

Height

Weight

Tent Required:

Yes

No

This is the travel partner I would like to share with.

Do you need any other equipment? (Miscellaneous equipment is available for rent)

All trips and courses offer tent accommodations on the beach. As a guest,you may prefer to stay at a reduced rate, at our Rock Island Lodge which offers nicely appointed, clean rooms with beautiful views of Lake Superior in a bed & breakfast environment.

Accommodation requested:

Yes

No

Share with:

Dates:

Continue to Diet/Medical form

Please rate your canoe/kayak experience.

Fair

Good

Excellent

N/A

Please rate your swimming ability.

Fair

Good

Excellent

N/A

Please rate your hiking ability.

Fair

Good

Excellent

N/A

Please rate your wilderness camping experience:

Fair

Good

Excellent

N/A

What are you most looking forward to?

Do you have any concerns?

Lodge Based Workshop Participants can continue to the next page.

Trip and course participants please complete the following as applicable:

Diet and Medical Information

Health Care Provider (US guests)

Emergency Contact

Birth Date

Male

Female

What was the date of your last tetanus shot? (required every 10 years)

Please evaluate your health

Fair

Good

Excellent

Please describe any medical, physical or mental health conditions that may affect your participation.

Please list any food/drug/environmental allergies. (Please include your reaction and severity if exposed):

Please list any regular medications you are taking and for what condition:

Please list any recent injuries and/or major illnesses:

Please advise of any dietary restrictions, dislikes or preferences:

Total cost: $

Deposit enclosed: $

(Deposit 20% or $100.00 whichever is more. Balance due 30 days prior)

Payment Information

Visa

MasterCard

Expiry Date:

I agree to the terms and conditions of registration and understand I will be required to complete and sign all required forms including a standard liability release before participating in any activity.

Payment

Trip Name

Card Number

Thank you very much!

Our staff will contact you shortly to confirm your trip registration.

In the meantime, start your planning by checking out our "What to Bring" Section

“The meals were better and the guides better looking than I expected!”

L. Cooper, Beavercreek, OH