sea kayak symposium - Barrier Island Kayaks :: Sea ...

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sea kayak symposium

REGISTRATION for JUNE 5-9, 2013

Contact Information Reg. page 1/2

Name:___________________________________________________ Date:_____________________
Street Address:________________________________________________________________________
City:_____________________________________________________ State:_____ Zip:___________
Day Phone:_______________________________ Email:_____________________________________

Symposium Registration $450 Registration $_________
$135 per day/$20 per dinner $_________
Option 1: Full 5 day course (Wed through Sun)
Option 2: “ala carte” day courses

Kayak Rental

Rotomolded kayaks will be available for rental if you’re not bringing a boat. We’ll need your height and weight for proper

boat fitting. $45 a day or $175 for Wednesday through Sunday $_________

Height: _______ Weight: ______ Dates Needed: ________ ________

Boat preference (we will try to get you as close as we can): ________ ________ ________ ________ _______

Assessments: 2-star____ 3-Star ____ $_________

Standard BCU Assessment Fees are extra. Add $10/members or non-members for 2-star; $15/members

and $25/non-members for 3-star. HELMETS & TOW BELTS ARE REQUIRED FOR SEA TRAINING AND/OR ASSESSMENT

Course Selection: Please check off your selections

Wednesday, June 5 Friday, June 7 Saturday, June 8 Sunday, June 9
Boat Repair [ ] Essentials to Sea Kayaking D2 [    ] Finesse with Farrow [    ] Performance Paddling Sea [    ]
Gear Talk [ ] 3 Star Training Sea D2 [    ] Advanced Rescues 3 Star Assessment  [    ]
SUP Demo [ ] Intermediate /Advanced and Towing Sea [    ] Nature Paddle [    ]
Surf Training  [    ] Wind, Weather and Tides [    ] Intermediate/Advanced
Thursday, June 6 Basic Coastal Navigation  [    ] Incident Management [    ] Surf Training[    ]
Performance Paddling Rescues and Towing  [    ] Support Strokes 9-12 [    ] Intro Surf Training [    ]
Flat Water [ ] Support Strokes 9-12 [    ] Intro Greenland Style 9-12 [    ] Support Strokes 9-12 [    ]
Incident Management [ ] Rolling 1-4  [    ] Rolling 1-4 [    ] Intro Greenland Style 9-12 [    ]
Support Strokes 9-12 [ ] Dinner – Low Country Boil Intro to Surf [    ] Rolling 1-4 [    ]
Rolling 1-4 [ ] Dinner – Southern Cuisine Finesse with Farrow [    ]
Essentials of Sea & Music
Kayaking D1 [ ]
3 Star Training D1[ ]
Intro To Sea Kayak Surf [ ]
Presentation [ ]

Barrier Island Kayaks | 160 Cedar Point Blvd. | Swansboro, NC 28584 | 252.393.6457 | www.barrierislandkayaks.com

Southern outer banks Connecting you to the natural world

sea kayak symposium

REGISTRATION for JUNE 5-9, 2013

Reg. page 2/2

Method of Payment

Make checks payable to: Barrier Island Kayaks, return with this form to 160 Cedar Point Blvd, Swansboro, NC 28584

Credit Card: MasterCard____ Visa____ Expiration Date: ______ ______

Card Number: __________-__________-__________-___________

Name as it appears on card: ________________________________ TOTAL: $ ______________

Signature: _____________________________________________

Refund Policy

We do recommend that you obtain travel insurance. Overhead costs incurred preclude refunds due to inclement weather.

Medical Conditions:

Our coaches and guides would like to make sure that we are aware of any conditions that our fellow paddlers have so that
we can respond appropriately to certain circumstances. Please circle any of the following medical conditions:

Any Allergic Reactions Anemia Asthma Back Problems
Heart Conditions Epilepsy
Diabetes Herniated Disk

Other: _____________________

Please make any notes about any medical concern or condition our coaches and guides should be aware of:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Please note special dietary requirements if any:
__________________________________________________________________________________________

Emergency Contact

Please give a contact name and phone number that we may use in the event of an emergency.

Name: _______________________________ Relationship:____________________

Phone Number: (_____) ______ - __________

Barrier Island Kayaks | 160 Cedar Point Blvd. | Swansboro, NC 28584 | 252.393.6457 | www.barrierislandkayaks.com

WAIVER & RELEASE

Connecting you to the natural world

This document affects your legal rights. It must be signed by you, the Participant whether you are Waiver page 1/2
an adult or minor, if you are renting or otherwise using equipment or participating in activities of-
fered by BARRIER ISLAND KAYAKS. It must signed also by your parent or guardian if you are a minor
Participant (under 18 years of age.) The parent or guardian agrees to these terms individually and
on behalf of the minor. Only a parent of legally appointed guardian may sign for a minor Partici-
pant. References in this agreement to I or we include all who sign below unless otherwise clearly
indicated.

In consideration of BARRIER ISLAND KAYAKS furnishing services and/or equipment to enable me to
participate in the sport of SEA KAYAKING, I agree as follows:

I fully understand and acknowledge that outdoor recreational activities have:

(A) inherent risks, dangers and hazards and such exists in my use of SEA KAYAKING equipment and
my participation in SEA KAYAKING activities;

(B) my participation in such activities and/or use of such equipment may result in ailments that
could cause serious disability;

(C) these risks and dangers may be caused by the negligence of the owners, employees, officers or
agents of, but not limited to BARRIER ISLAND KAYAKS, the negligence of the participants, the negli-
gence of others, accidents, breaches of contract, the forces of nature; such as, exposure to sun, cold,
wind, hail, lightning, and other phenomena; activities may take place in remote places significantly
delaying emergency medical care and evacuation or other causes. Risk and dangers may arise from
foreseeable or unforeseeable causes including, but not limited to, guide decision making, including
that a guide may misjudge weather, route location, tides, water conditions which may be fast, deep,
cold and subject to rapid change; objects which may be encountered in and out of the water, and
which may not be obvious, including debris, trees, rocks, bridges, and other hazards; the watercraft
may overturn, swamp and sink and occupants may become separated from the craft; feet and other
parts of the body may become entrapped in or under rocks and other objects; participants may
strike or be struck by objects, other watercraft, and other persons, in and outside of the watercraft,
wind, risks of falling out of or drowning while in a kayak, and other such risks, hazards and dangers
that are integral to recreational activities that take place in a wilderness, outdoor or recreational
environment;

(D) further, by my participation in these activities and for use of equipment, I hereby assume all
risks and dangers and all responsibility for any losses and/or damages, whether cause in whole or
in part by the negligence or other conduct of the owners, agents, officers, or employees of BARRIER
ISLAND KAYAKS, or by any other person.

I on behalf of myself, my personal representatives and my heirs hereby voluntarily agree to release,
waive, discharge, hold harmless, defend and indemnify BARRIER ISLAND KAYAKS, and their owners,
agents, officers, and employees from any and all claims, actions or losses for bodily injury, property
damage, wrongful death, loss of services or otherwise which may arise out of my use of kayaking or
my participation in SEA KAYAKING activities. I specifically understand that I am releasing, discharg-

Barrier Island Kayaks | 160 Cedar Point Blvd. | Swansboro, NC 28584 | 252.393.6457 | www.barrierislandkayaks.com

WAIVER & RELEASE

Connecting you to the natural world

ing and waiving any claims or actions that I may have presently or in the future for the negligent Waiver page 2/2
acts or other conduct by the owners, agents, officers, or employees of BARRIER ISLAND KAYAKS.

I authorize Provider to provide or obtain for me, or the minor child for who I sign, such medical care
as it considers necessary and appropriate and I agree to pay all costs associated with such care and
related transportation. Any dispute between Provider and me or the minor child for whom I sign
will be governed by the substantive laws of the State of North Carolina (not including laws which
might apply the laws of another jurisdiction), and any mediation or suit shall take place only in that
State, in the County of Carteret. If the dispute cannot be resolved by mutual agreement, I agree to
submit it to a mediator recognized by the Courts of that State and County. I agree to pay all costs
and attorneys’ fees incurred by Provider in defending a claim or suit brought by me or by or on be-
half of the minor for who I sign, if the claim or suit is withdrawn of to the extent a court or mediator
determines that Provider is not responsible for the claimed injury or loss.

This agreement is entered into voluntarily, and after careful consideration. Its terms cannot be
amended except in writing. I understand that it is binding, to the fullest extent allowed by law,
upon all persons signing below, our respective heirs, executors, administrators, wards, minor
children (whether of not they are Clients) and other family members. If any part of this agreement
is found by a Court of other appropriate authority to be invalid, the remainder of the agreement
nevertheless shall be in full force and effect.

The staff of BARRIER ISLAND KAYAKS reserves the right to refuse participation in any BARRIER
ISLAND KAYAKS activity if we have reason to believe that the participant is under the influence of
alcohol or any other substances that may impair judgment and reduces a participants ability to ef-
fectively manage the risks of kayaking. This includes but is not limited to daily or multi day rental as
well as single and multi day guided trips.

I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE. IT IS MY INTENTION TO
EXEMPT AND RELIEVE BARRIER ISLAND KAYAKS FROM LIABILITY FOR PERSONAL INJURY, PROPERTY
DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OF ANY OTHER CAUSE. IN ADDITION
TO THIS WAIVER AND RELEASE I HAVE READ AND FULLY UNDERSTAND ANY POSTED OR VERBAL
SAFETY GUIDELINES.

SIGNATURE:__________________________________________________________
NAME (please print):_________________________________________________
DATE OF ACTIVITIES from ____/____/____ to ____/____/____
ADDRESS OF PARTICIPANT (please print)
Street:_______________________________________________________
City: _____________________________ State: ________ Zip: _________________

Barrier Island Kayaks | 160 Cedar Point Blvd. | Swansboro, NC 28584 | 252.393.6457 | www.barrierislandkayaks.com