Whitewater Instructor CourseMay 8/9
The Canoe Tasmania Whitewater Instructor Course will be held at the ForthRiver and other rivers in the area on May 8/9.
This course is for people who have some Grade 3 whitewater paddling experience and wish to instruct and lead trips on Grade 2 whitewater. The weekend will also include personal skills coaching from some of Tasmania’s best whitewater paddlers.
The weekend course will be based at the Tasmanian Canoe Club Course, with camping accommodation on Saturday night included in the course fee. Participants are expected to provide their own kayak and paddling gear. A list of what to bring and further information about the course will be provided on receipt of the enrolment form and fees.
The Tasmanian Schools Whitewater Championships will be on at the same time at Forth, so teachers who are attending this course are welcome to bring students along for a weekend of river paddling or racing with other students from around Tasmania.
A fee of $140 is payable to Australian Canoeing to obtain registration as an Australian Canoeing Instructor when the assessment process is completed. People who already hold an AC Instructor Award eg a Flatwater Instructor Award only need to pay an additional fee of $20 rather than another $140. This fee can be paid to Canoe Tasmania at the time of registering for this course to simplify invoicing.
Enrolment Form
Name:………………………………………………………………………………… D.O.B:………………………………
Street address:…………………………………………………………………………….
Suburb:……………………………………………………….... P/Code:………………
Phone: (Mobile or best number to contact you on during work hours)……………………………………….
Email:……………………………………………………….
Emergency contact name and phone number: …………………………………………………………………………...
Previous paddling experience (include Grade 2-3 trips paddled and craft used) ………………………………………………………………………………………………………………..…………………………………………………………………………………………………………………....
COST: $250(+ $140 if choosing to pay the AC instructor registration fee now)
Enrol me in the Canoe Tasmania Whitewater Instructor Course
I have signed the attached wavier, medical information and transport forms
I have enclosed payment or a transaction receipt for the course fee
Return this form to Andrea McQuitty: Payment by cheque, postal order or
Email: Direct deposit: Canoe Tasmania Inc
Post: 4 Beach St, Leith, 7315 Connect: BSB 807009 Acc No. 12245398
MEDICAL QUESTIONNAIRE & CONSENT FORM
Please complete the following by circling the relevant answer.
1. Do you suffer from any medical condition, illness, injury or disability that may interfere with or be aggravated by the proposed activity? YES / NO
If YES, please give details ………………………………………………………………………………………………………
2. Is the abovementioned condition likely to require any special attention, treatment or medication during the activity? YES / NO
If YES, please give details ………………………………………………………………………………………………
3. Have you ever had a serious allergic reaction to an insect, animal or plant? YES / NO
If YES, please give details (including reaction & treatment)
………………………………………………………………………………………………………
4. Can you swim the length of an Olympic Swimming pool? YES / NO
INDEMNITY AGREEMENT & WAIVER of LIABILITY
Teaching, Training & Assessment Events – Canoe Tasmania Inc
Participant's name: …......
I / we hereby acknowledge and understand that I / my son / my daughter / my dependant will be participating in a Canoe Tasmania Canoe Education event, and that I fully understand the nature of the activity to be undertaken after having read and understood any printed material supplied to me and after making enquiries to my satisfaction.
In consideration of the Canoe Tasmania Inc. providing this activity for me / my daughter / my son / my dependant I hereby acknowledge that Canoe Tasmania Inc. and Australian Canoeing Inc., their Instructors, employees, officers, servants and agents shall not be liable for any injury, damage, loss, claim or demand whatsoever which may arise during, or in association with, participation in or travelling to or from the activity unless the same is caused by negligence or a criminal act on the part of the said Canoe Tasmania Inc. or Australian Canoeing Inc., their Instructors, employees, officers, servants and agents and I / we hereby agree to indemnify and keep indemnified the said Canoe Tasmania Inc, Australian Canoeing Inc., their Instructors, employees, officers, servants and agents against all actions, suits, damage claims and demands arising out of any accident, loss or illness which may befall me / my son / my daughter / my dependant during or as a result of my / his / her participation In any activity or function connected with the event or whilst travelling to or from the said event unless the same is caused by negligence or a criminal act on the part of the said Canoe Tasmania Inc. or Australian Canoeing Inc., their Instructors, employees, officers, servants and agents.
Signed by: ……………………………………………………………………. Date: …………………
(To be signed by Parent or Guardian if participant under 18 years of age)
Name (printed): ......
CONSENT FOR EMERGENCY TRANSPORT &/OR MEDICAL ATTENTION
I,…………………………………………………………….. (full name) of ……………………………..………………………………………..( address )
hereby give consent to being transported by Ambulance or other appropriate transport to the nearest medical centre or hospital for emergency or life preserving treatment by an appropriately qualified medical person.
It is understood that such treatment would be at my expense.
Signed: …………………………………………………….
Dated this ……(day) of …….(month), 2010.
Signed by parent if applicant is under 18 years:
……………………………………………………
Name:……………………………………………..