Registration information

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Date	19.10.2016
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Kayak Carolina

Paddling the Carolina Coast since 1998

621 S. 5^th Ave. Kure Beach, NC 28449

Phone 910-458-9171

www.kayakcarolina.com

REGISTRATION INFORMATION One per family/group/person/address.
□ Rental		□ Tour	□ Lesson
^{First Name(s)}		^{Last Name(s)}	^Age(s)
^1.
^2.
^3.
^4.
^5.
^6.
^{Permanent Address}		^{City, State}	^Zip

^{Local or Mobile Phone}		^{Local Address}	^E-mail

How did you hear about us? Thank you. 		 Website  Facebook  Coupon Book  Yelp  Friends/Family  Trip Advisor  Drive By  Other _______________________
Please complete the following. Please let your guide know if you have any of the following conditions.
Are you allergic to bees, ants, or stings?  Yes  No If yes, please list name and the allergies:	If yes, what medications/procedures do you follow to treat your allergic reaction? List name(s) and treatment individually.
Are you diabetic or have any other condition that requires immediate medication or treatment if it occurs?  Yes  No	If yes, please list name(s) & conditions: _________________________________________
Have you had any recent injuries or surgeries that would limit your activity?  Yes  No	If yes, please list injuries/surgeries:
If yes to any of the above, do you have your proper medication(s)/treatments with you?  Yes  No	If yes, please list:
 I notified the guide if I have any of the above conditions.

______ For kayaking activities, shoes must be worn at all times, FLIP-FLOPS are discouraged.

______ Kayak Carolina’s PFD’s (personal flotation devices) are to be worn and zipped at all times for any kayaking activities.

______ It is highly recommended that each participant bring bottles of water and sunscreen to have on hand while participating in activities.

Emergency Information - Please provide us with a contact person in the event of an emergency.

Name:		Day Phone:
Relationship:		Eve. Phone:

Thank you for paddling with us today!  Tipping your guide according to performance is customary and appreciated.

We appreciate your business. Guides of Kayak Carolina

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