Burlington Able Sail
841 LaSalle Park Road
Burlington, ON L7T 4G6

Charitable Registration - 84584 8100 RR0001

 

 

Registration Form for Sailing Instruction for
Individuals with Physical and Cognitive Challenges

We have need of people with a wide variety of skills and interests. Please indicate your skills in the list below. No skills are required and training is available.

 

Title

First Name*

Last Name*

Address*

Address 2

City*

State/Province*

Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip/Postal Code*

Email Address*

Confirm Email Address*

Phone*

Emergency Contact Name*

Emergency Contact Phone Number*

What special needs do you have?

Are there any other issues we should be aware of?

Do have a need for lift transfer?*

yes

no

Are you diabetic?*

yes

no

Do you have seizures?*

yes

no

Desired date?*

Monday

Tuesday

Wednesday

Thursday

Desired Time?

10am

12pm

2pm

4pm

Sailing skills*

none

recreational

competitive

Enter the code displayed*