Pre-Clinic Participant Information If you are human, leave this field blank.Participant InformationPlease 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 to other participants.Course Name *Please select your upcoming course(s) from the list below:Fundamentals for River RunnersCombat RollingSlalom for River RunnersFreestyle FocusAdvanced Common Sense RescueACA Instructor Development WorkshopAdvanced Green River SchoolPrivate/Custom Group InstructionIntro to RollingWinter Pool SessionFundamentals of CreekingCommon Sense RescueAdvanced CreekingBig Water BootcampGreen River SchoolGreen River After SchoolOcoee Youth RetreatBOOST Open Practice SessionsName *Date of Birth *Phone *Email * *I acknowledge H2o Dreams LLC personal liability policyMedical Insurance CompanyInsurance Policy Number Emergency Contact InformationIn case of emergency, please contactName *Relationship *Phone *Email * Vital InformationHeight *Weight *Are you currently under the treatment for any illness or condition? *yesnoPlease describeAre you currently taking any form of medication? *yesnoPlease describeHave you had any injuries or undergone surgery in the past? *yesnoPlease describeDo you have any allergies? *yesnoPlease describeDo you or anyone in your family have history of heart related problems? *yesnoPlease describeHave you ever had heat or cold related injuries? *yesnoPlease describeCan you swim? *yesnoDo you wear eyeglasses or contacts? *yesnoDo you smoke? *yesnoDo you have any dietary restrictions? *yesnoPlease describeAny other medical related information we should know? Pre-Clinic Student AssessmentThis is an elective section for additional information to help develop your instructional experience with H2o Dreams. We recommend if you have had previous experiences on whitewater then to please answer the questions below to the best of your ability. If you feel you cannot adequately answer one of the below questions, feel free to leave blank.Have you ever had any formal instruction?yesnoIf 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?Have you taken a Swiftwater Rescue course in the past year? Some of our courses require rescue skills as you are an active part of the group safety. yesnoCPR and FA?Some of our courses require rescue skills as you are an active part of the group safety. yesnoHow often do you paddle? About how long do you paddle during each outing?What rivers do you run regularly?Do you run all the main lines/rapids? Do you explore new lines?Describe your most challenging day of paddling. What was the quality of that experience?Describe your paddling group. What is your role within that group?What equipment do you carry with you while paddling?Please be thorough! use this space to details what gear you will bring with you for a 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 (an unplanned roll on the river)? When was the last time you had a swim? Describe what led to those experience(s).Self RescueSelf-rescue is defined as a safe, controlled wet-exit and recovery of equipment to shore.Self-rescue in flatwaterSelf-rescue in class IISelf-rescue in class IIIRolling AbilityCannot rollPool roll and sometimes in currentCan roll most of the time in class II-IIICan roll most of the time in class IV-VRolling VariabilityI can roll on one side onlyI can roll on both sidesI know variations of rolls and can roll on both sidesHow comfortable are you with dynamic inversion?Your kayak is flipped dynamically and unexpectedly and the environment is cold, dark, shallow, or turbulent. Extremely uncomfortable. I will probably swimSomewhat uncomfortable. I might attempt a roll.50/50. My success will be dependent upon other factors, like familiarity with the river and how the day has been going.Comfortable. I experience a lot of success in these situations.Extremely comfortable. Most of my day is filled with desire for dynamic situations and/or with great frequency.Rate yourself 1-5 on the skills below. 1 being the least developed and 5 being the pinnacle.Overall river and group awarenessScouting from shoreScouting from boatReceiving beta (info about rapids/line)Giving betaIdentifying hazardsAbility to see line and executeRead and run whitewaterControlling pitch, roll, and spin of kayakKnowledge and use of basic strokes and biomechanicsCompound strokesCatching small eddiesCatching powerful eddiesUsing features for deliberate movement on the riverBoofing technique (various styles and use)Intentional surfingUnintentional surfingHow do you deal with fear and intimidation?Have you ever had a traumatic experience, gone blank, not remembered, or had any setbacks - paddling or otherwise - that may be 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 agreeCaptcha *reCAPTCHA is required.Submit
