To apply, please print or download this form, save and rename using your last name, and email or snail mail to:

Email to Teresa Moore at: This email address is being protected from spambots. You need JavaScript enabled to view it.

Mail to: Palmetto Paddlers PO Box 984, Columbia SC 29202-0984

Application deadline is: March 16, 2019 for a postmarked mailed application

March 22, 2019 for an emailed application


Applying for funding for: ACA River Kayak Instructor ___

ACA River Canoe Instructor ___

ACA Coastal Kayak Instructor ___

ACA Swiftwater Rescue Instructor ___

Name: _________________________________________________________________

Home Address:  _________________________________________________________

City, State, Zip code: _____________________________________________________

Home or Cell Phone:  _____________________________________________________

Email Address: (print carefully) _____________________________________________


1. When did you join Palmetto Paddlers? _____________________________________

2. When did you begin paddling? ___________________________________________

3. Have you previously taught kayaking, canoeing or rescue? Yes ___ No ___

a. What type of course or clinic did you teach ______________________________

b. In what capacity? Lead Instructor ___ Assistant Instructor ___ Other __________

c. When did you teach _________________________________________________

4. Have you ever been the Trip Coordinator or the Contact person for a Palmetto Paddlers club trip?

Yes ___ No ___ If yes, provide details____________________________________________

5. Have you ever taken a Swift Water Rescue Class or a Basic Water Safety Course?

Yes ___ No ___ If yes, provide details____________________________________________

6. What level would you rate your paddling ability? ______________________________________

a. List the rivers or bodies of water that you paddled last year. (Include sections, e.g., Section 4 Chattooga) __________________________________________________________________

b. List the rivers or bodies of water that you paddled more than one year ago. (Include sections, e.g., Section 4 Chattooga) ______________________________________________________

7. What is your swimming ability? Basic ___ Intermediate ___ Advanced ___

8. What other types of current applicable certifications and or licenses do you hold?

CPR ___ First Aid ___ First Responder ___

EMT/Paramedic ___ WFR ___ WFR-EMT ___

Licensed Teacher ___ Lifeguard ___ Other ___

ACA Instructor ___ Other Medical License ___

If you checked ACA Instruction or Other, please describe here ______________________________

9. Are you an American Canoe Association Member? Yes ___ No ___

10. Please list any other relevant experience, such as offices or special duties that you have held within Palmetto Paddlers or other clubs. Extra pages may be attached.




Completion of this form does not automatically qualify you for funding. The Safety and Instruction Committee will review your application and you will be notified of their decision at the earliest possible convenience. If you are chosen to receive funding and successfully receive ACA instructor certification, the club will reimburse you up to $250 for tuition paid by you. By signing this form you assert that all of the information that you have given is factual.


Print name: ___________________________________________________________


Signature: _____________________________  Date:__________________________

(You may type your name on the signature line for an emailed application)


Palmetto Paddlers encourages all recipients of these awards to coordinate club trips and to assist in club-sponsored instruction programs, such as water safety clinics, paddling instruction, etc.

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