First Name *
Last Name *
Birthdate (MM/DD/YYYY) *
Address *
City *
Postal Code *
Phone Number *
Email Address *
Do you have any medical or health issues, including allergies? *

Are you joining the team as a person with lived experience? * YesNo
Are you joining the team as a family member? * YesNo
Are you joining the team as an employee in mental health field? * YesNo

How did you hear about Conquering Waves Dragon Boat Club? * —Please choose an option—FriendFamilyE-mailWebsiteSocial MediaOther
Have you paddled in a Dragon Boat before? * —Please choose an option—YesNo
If yes, how many years?
What is your reason for joining Conquering Waves Dragon Boat Club? *

Do you receive services from any of the following (check all that apply): * Art Studio Open Door GroupCoast Mental Health UBC or VGHSTEPS Mental Health TeamGet Set & Connect EPIKettle Friendship Society Gastown Vocational ServicesOther

If you selected "Other" or "STEPS Mental Health", please specify:
Emergency Contact Name *
Emergency Contact Phone Number *