2024 DNEM Adaptive Kayak Registration 
 Please use this form to register for one of Disability Network Eastern Michigan's Adaptive Kayaking Workshops.  You will receive a confirmation email indicating that your registration information was received.  Prior to your workshop date, you will receive an email with all the details for your kayak workshop; including address, parking information, and what to wear.  If you have any questions, please contact our  RecConnect: Adaptive Recreation Department at rec-it@dnemichigan.org 

Please complete all required fields with information on the person who will be kayaking.  
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First and Last Name   *
Email Address  *
Street Address  *
City *
Zip Code *
Kayaking is a service for people with disabilities who live in one of the 7 counties we serve:  Oakland, Macomb, St. Clair, Lapeer, Tuscola, Sanilac, and Huron.  Please indicate in which county you reside: 
 *
Participant Date of Birth  *
Due to the necessary adaptive equipment, we are unable to assist kayakers under the age of 8 years old at this time. 
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Phone Number (preferably mobile) *
Do you have any kayak experience?  *
Do you have any allergies?  Please indicate below:  *
Please indicate approximate weight of the kayaker:

 *
Emergency Contact Name: *
Emergency Contact Phone Number:  *
Please indicate any/all disabilities:   *
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