There are 4 steps to this medical form. Please take the time to answer all the questions. This information helps BLACK BEAR KAYAK staff manage risks and plan effectively for this kayak & camping trip.
Have you ever had, or are you prone to any of the following:
If you answered yes to any of the above conditions, please take a moment to provide details so that wecan better help you manage your safety during this program.
Tetanus Shots are valid for 10 years. A current Tetanus shot is required for all BLACK BEAR KAYAK programs
Please print this summary and bring it on the day of your tour.
If you are bringing medication with you
Black Bear Kayak Inc. and your Privacy The personal information collected in this form is used by BLACK BEAR KAYAKING INC. staff to help manage the safety of the group. The information is stored at the BLACK BEAR KAYAKING INC. offices for 5 years and then destroyed. Until then we WILL NOT share, trade or sell any information we collect from you. If you have concerns about the privacy and security of this information, let us know before filling out the form. You can always approach our staff privately before, at the beginning or during a program to verbally address any medical concerns you have.
Underage participant: In the case of the participant being under the age of nineteen (19) in the Province of British Columbia, or under the age of responsibility elsewhere, I hereby give permission to a trip representative of BLACK BEAR KAYAKING INC. to arrange for any medical treatment required by my child or ward while she/he is under the care of the chaperone or guide during the program named above.