Loading...

BLUE DOG KAYAKING

COVID 19 CUSTOMER DECLARATION

TO BE COMPLETED THE DAY BEFORE TAKING LESSONS, A TOUR OR RENTING A KAYAK OR PADDLEBOARD

If you have answered YES to any of these questions and are exhibiting any of the above symptoms please stay at home and DOT NOT attend your course, tour or rental booking. Please call us and we will work with you to reschedule or refund you.

By taking one of our courses, tours, or renting a kayak, you consent that: Any activity involves some risk of COVID-19 transmission. We are following a protocol to reduce or mitigate risk, but that risk cannot be reduced to zero. You are attending despite some risk.

 

Date: October 26, 2021

PASSIONATE ABOUT PADDLING, MAKING LEARNING FUN FOR ALL
250 710 7693
Email: paddle@bluedogkayaking.com
Website: http://www.bluedogkayaking.com

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 19 years of age or older
First Participant's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 19 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 19 years of age or older
Parent or Guardian's Information
Have you arrived in Canada from a foreign country in the last 14 days*
No
Yes
Have you been in contact with anyone who has COVID 19*
No
Yes
Are you experiencing a fever*
No
Yes
Are you experiencing a dry cough*
No
Yes
Are you experiencing tiredness*
No
Yes
Are you experiencing aches and pains*
No
Yes
Are you experiencing a sore throat*
No
Yes
Are you experiencing a headache*
No
Yes
Are you experiencing difficulty breathing or shortness of breath*
No
Yes
Are you experiencing chest pain or pressure*
No
Yes
Are you experiencing loss of speech or movement*
No
Yes
Does your level of fitness prevent you from kayaking or paddle boarding*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!