Day Paddler | Cork Dragons

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Day Paddler Registration

First Name

Last Name

Email

Phone

How did you find out about us?

Can you swim 50 m? * Required

Yes

No

Are you a breastcancer survivor? * Required

Yes

No

Date of Birth * required

Emergency Contact Name

Emergency Contact Phone

Is there anything else we should know - diabetic, heart condition, fear of water, asthmatic...

PFD (Personal Floatation Device) Size * Required

S

M

L

XL

By joining the Cork Dragons I agree to my photo being used on social media and that I have read the Information Booklet provided

Thank you for your submission

Privacy Policy

Cork Dragons Charity Number CHY 20638

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