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Pre-Clinic Participant Information

H2o Dreams > Pre-Clinic Participant Information

Participant Information

Please fill out the following form as detailed as possible. Information given will be treated with the strictest confidentiality. Any vague or incorrect information could result in the injury or death of yourself or other participants.

Course Name *
Please select your upcoming course(s) from the list below.Fundamentals for River RunnersIntro to RollingCombat RollingPool SessionSlalom for River RunnersFundamentals of CreekingFreestyle FocusCommon Sense RescueAdvanced Common Sense RescueAdvanced CreekingBig Water BootcampACA Instructor Development WorkshopGreen River SchoolGreen River School – After SchoolAdvanced Green River SchoolOcoee Youth RetreatBOOST Open Practice SessionsPrivate / Custom Group Instruction

For private / custom group instruction, please provide the following details:

Instructor Name & Date(s) of Instruction *
Are you a part of a group? *
YesNo
If yes, please provide the name of your group’s coordinator. *

Participant Information

Name *
First

Last
Date of Birth *
Phone *
Email *
You should have adequate insurance to cover any injury or damage that you may cause or suffer while participating in an H2o Dreams LLC activity, or, you fully agree to bear the costs of such injury or damage to property. *
I acknowledge H2o Dreams LLC personal liability policy
Medical Insurance Company
Insurance Policy Number

Emergency Contact Information

In case of emergency, please contact:

Name *
First

Last
Relationship *
Phone Number *
Email *

Vital Information

Height *
Weight *
Are you currently under treatment for any illness or condition? *
yesno
If so, please describe
Are you currently taking any form of medication? *
yesno
If so, please describe
Have you had any injuries or undergone surgery in the past? *
yesno
If so, please describe
Do you have any allergies? *
yesno
If so, please describe
Do you or family have any history of heart problems? *
yesno
If so, please describe
Have you ever had heat or cold related illnesses? *
yesno
If so, please describe
Can you swim? *
yesno
Do you wear eyeglasses/contacts? *
yesno
Do you smoke? *
yesno
Do you have any dietary restrictions? *
yesno
If so, please describe
Any other information we should know?
Please describe below

Pre-Clinic Student Assessment

Do you require a Rescue PFD for class? *
Applicable only for Common Sense Rescue, ACA IDWs, and Advanced Creeking.YesNo
Have you ever had any formal instruction? *
YesNo
If yes, where did you receive instruction, and how much instruction have you had? If no, how did your paddling skills get to where they are today? *
How often do you paddle? About how long do you paddle during each experience? *
What rivers do you run regularly? *
Do you run all of the main lines / rapids? Please describe. *
What is the hardest section of river you have paddled? What was the quality of that experience? *
Describe your paddling group. What is your role within that group? *
Have you ever taken a swiftwater rescue course and/or First Aid / CPR training? Have you ever had to use these skills? *
What equipment do you carry with you while paddling? *
Be thorough! Use this space to detail what gear you will bring with you for class as well as any equipment needs you may have from H2o Dreams.
At what skills do you excel? What skills need work? *
When was the last time you had a combat roll? When was the last time you had an out of boat experience? Describe the quality of those experience(s). *
Rolling Ability *
Rescue ability *Self-rescue is defined as a safe, controlled wet-exit and recovery of equipment to shore.
How comfortable are you with dynamic inversion? *Imagine being flipped dynamically and unexpectedly. It might be cold, dark, shallow, or turbulent.

Rate yourself from 1-5 on the skills below. 1 being the worst, and 5 being the best.

Overall river and group awareness *
Scouting from shore *
Scouting from boat *
Receiving beta (info about rapids / lines) *
Giving beta (info about rapids / lines) *
Read and run whitewater *
Identifying hazards *
Ability to see a line and execute *
Catching small eddies *
Catching powerful eddies *
Flaring boofs *
Ledge boofs *
Water boofs (waves, holes) *
Controlling pitch, roll, and yaw of your kayak *
Knowledge of strokes *
Compound strokes *
Using features *
Intentional surfing *
Unintentional surfing *
How do you deal with fear and intimidation? *
Have you ever gone ‘blank’ or not remembered, ie: running a rapid or the details of a particular river experience? Please describe. *
What’s your greatest fear? *
Have you had any setbacks- paddling or otherwise- that may be preventing or complicating success and enjoyment on the river? *
By submitting this form, I certify and acknowledge that I have read this document thoroughly and that all the information I have provided is correct and accurate. *
I agree.

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