ACA Assessment Course Report Form - ACA | Canoe - Kayak - SUP - Raft

ACA Assessment Course Report Form

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This form is to be submitted along with all associated fees by the Head Instructor/Instructor Trainer/ITE within 30 days of the course completion. Only one course can be reported per report form. You will have the opportunity to upload the Course Roster at the end of this form. Click here to access a blank roster to fill out, save and upload.

Assisting Instructors
Assessment Information *Please indicate the assessment course.	Coastal Kayak Day-Trip Leading Assessment Coastal Kayak Skills Assessment River kayak Day-Trip Leading Assessment River Kayak Skills Assessment Surf Kayak Skills Assessment River Canoe Day-Trip Leading Assessment River Canoe Skills Assessment Safety and Rescue Skills Assessment
Level *
Course Dates *
Venue/Waterway *		City/State *
Contact Person *
Head Instructor: First Name *		Last Name *
ACA# *		Email Address
Phone Area Code		Phone
Address Line 1		Address Line 2
City
Location		Zip/Postal Code
Please list all assisting instructors.
NameAssisting Instructor		ACA#
NameAssisting Instructor #2		ACA#
NameAssisting Instructor #3		ACA#
Insurance
If this course was insured by ACA Insurance, please send in the original, unaltered ACA Waiver and Release of Liability forms for each participant and instructor.
Insured? *Was this course covered by ACA Insurance?
Paddle America Club? *Was this course conducted through a Paddle America Club/ACA Affiliate?
Club/Affiliate NameIf yes, please note the Club/Affiliate name.
Participants
All Assessment Course participants are required to be current ACA members. If non-ACA members participate, they must become ACA members before Assessment Documentation will be processed. This can be done by sending the new member information in with the applicable fees, calling in to the Membership Department, or online.
Non ACA membersNumber of Non ACA members who attend your course		ACA Member Participants *
Total Amount Due *Total amount of event and membership fees due.
Payment Type
New Memberships
If you have New ACA membership with this report you MUST call the membership department (540-907-4460) to pay or mail in waivers and payment to the ACA office. 108 Hanover St. Fredericksburg, VA. 22401
Course Roster UploadYou can upload your course roster here.
Waiver Upload If you have used ACA insurance to cover your course, you may upload your ACA waivers here