WHY SEA NORTH TOURS
Our Commitment and Values
Beluga Whale Conservation
Beluga Whale Information
Our Team
Our Fleet
Press and Media
OUR SUBARCTIC SAFARIS
All Tours
Beluga Whale & Historic Fort Prince of Wales Tour
Zodiac Beluga Whale Watching
Floe Ice Tours
Zodiac Boat Charters
Kayaking
Paddleboarding
Sloop Cove Historic Site & Nature Walk
PLAN YOUR TRIP
How to Reserve
Preparing for Subarctic Safari
2020 Tour Times
Traveling to Churchill
Frequently Asked Questions
Churchill and Surrounding Area Map
Accommodations in Winnipeg
GALLERY
CONTACT US
RESERVE NOW
seanorth@mymts.net
WHY SEA NORTH TOURS
Our Commitment and Values
Beluga Whale Conservation
Beluga Whale Information
Our Team
Our Fleet
Press and Media
OUR SUBARCTIC SAFARIS
All Tours
Beluga Whale & Historic Fort Prince of Wales Tour
Zodiac Beluga Whale Watching
Floe Ice Tours
Zodiac Boat Charters
Kayaking
Paddleboarding
Sloop Cove Hike
PLAN YOUR TRIP
How to Reserve
Preparing for Subarctic Safari
2020 Tour Times
Traveling to Churchill
Frequently Asked Questions
Churchill and Surrounding Area Map
Accommodations in Winnipeg
GALLERY
CONTACT US
RESERVE NOW
Medical Form
Medical Form
Please note that you must be at least 18 years old in order to sign. If you are not 18 years old, please ask your parent or legal guardian to complete this process.
Which of the following tours have your purchased?
Kayak and/or Paddleboard Tour
Other
REQUIRED FOR ALL PARTICIPANTS THAT HAVE PURCHASED A KAYAK AND/OR PADDLEBOARD TOUR, 12 YEARS AND UP
Participants Name
*
First
Last
Email
*
Date of Birth
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
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11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Weight
Height
Medical insurance plan
yes
no
Please list name your carrier
Physical condition
(Required physical ability to lift oneself out of the water for Paddleboard tour)
Allergies, life threatening:
Allergies, non life threatening:
Are you on any medications (prescription or non-prescription)?
no
yes
If yes, please specify:
Have you been under a doctor’s care in the past 12 months?
no
yes
If yes, please specify:
Do you have a chronic disability or illness:
no
yes
If yes, please specify:
Do you have a history of any of these ailments:
Epilepsy
Diabetes
Susceptibility to colds
Headaches
Nosebleeds
Fainting
Asthma
Hay Fever
Emphysema
or others
no
If other, please specify:
Do you have a history of joint injury?
Tendonitis
Bursitis
Sprain
Dislocation
or other
no
If other, please specify:
Eyesight:
Excellent
Good
Fair
Poor
Glasses
Contacts
Do you have any physical limitations?
no
yes
If yes, please specify:
Do you feel that you have any psychological limitations? (i.e.. fear of water, fear of heights, etc.).
no
yes
If yes, please explain:
Date
Date Format: MM slash DD slash YYYY
Digital Signature:
The above medical information is complete and accurate. If any of the information changes, I will inform the Sea North Tours Office so that the changes can be recorded. I am in good physical condition to participate. I have read the Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement and agree to be bound by its terms and conditions. I agree to adhere to the rules and regulations set up by the Guides of Sea North Tours Ltd. to minimize risk and ensure safety.
Parent/Guardian Certification:
I certify that I am the parent or legal guardian of the above minor.
