First Name *

Last Name *

Street Address *

City *

State *

State (other)

Zip Code *

Email Address *

Phone *

What is the best way to reach you? *

Emergency Contact *

Emergency Contact Phone Number *

Membership Type *

Why are you interested in joining the Derby City Dragons? *

Date Diagnosed *

Where did you receive treatment and or surgery? (check all that apply) *

Are you currently undergoing chemotherapy? *

Can you swim? *

How did you learn about the Derby City Dragons? *

Please list your skills, hobbies, talents and interests. *

Please check which crews you would be interested in. (check all that apply) *

Behavior Expectations - The Derby City Dragons welcomes everyone who is a breast cancer survivor, or who is going through treatments. It is each member’s responsibility to be supportive, understanding and compassionate in helping teammates find their “inner dragon”. We expect members to be courteous and respectful of others; to accept the decisions of coaches/captains and the Board; strive for personal growth and improvement; proper representation of our organization at public events; show compassion, support and acceptance to all our teammates. Inappropriate behavior by members of the Derby City Dragons will not be tolerated and may result in suspension or termination of membership until review by the coach/captain and Board of Directors. These behaviors include, but are not limited to: inappropriate behavior while representing DCD; offensive language and comments aimed at teammates, unwillingness to participate in team activities; disrespect of decisions made the DCD leadership; substance abuse and blatant disruption of team activities. All members (paddling and non-paddling) shall sign up for scheduled activities in a timely fashion.Paddling members are asked to strive to paddle at least 1x/week).Paddlers are asked to sign-up for each practice AND notify the captain or coach in advance if you are not able to come to practice.All members are expected to take part in fundraising events, crew meetings and non-paddling workouts to the best of their ability. If a member is not able to attend an event for which they have signed up, the member must notify the coach/captain, crew chair ASAP. It is each member’s responsibility to notify the coach and/or captain of a health status change as soon as possible. Cancelations/No-showsFestivals – When we announce participation in a dragon boat festival, each full member will have the opportunity to sign up for the event. Should the member fail to attend the festival, the member will provide their reason to the coach. The coach will provide the explanation to the Board. If the Board feels the reason is not an excused absence, the team member will pay a $50 fee to Derby City Dragons before she is permitted to participate in additional festivals. If a member has signed up for a hotel room and it cannot be cancelled, that member will be responsible for the cost of the room.If that member was riding with someone to the festival, they will also be responsible for gas money.A team member is required to participate in 2 practices in the 2 weeks leading up to a festival in order to paddle in the festival.As with the festivals, if the team is paying towards an event and a member fails to attend, that member will be responsible for reimbursing the team for cost of the event.By submitting this registration, I agree to abide by the Derby City Dragon’s Paddler Agreement. *