Membership Application
Llanrwst Canoe Club membership application form
Email address *
Date of Birth *
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Applicant Name *
Your answer
Address *
Your answer
Mobile Phone number *
Your answer
Home Phone Number *
Your answer
Membership Type *
Adult 18 & above. Junior – under 18. Student – full time education post 18.
Household/Family Membership please note: Select the "Membership Type" for each applicant then contact the Treasurer for your discounted rates. Email - treasurer@llanrwstcanoeclub.org.uk
Household/Family Membership please note: Select the "Membership Type" for each applicant then contact the Treasurer for your discounted rates. Email - treasurer@llanrwstcanoeclub.org.uk
Do you intend to pay via BACS? *
Required
Emergency Contact Details
Please provide details of who should be contacted in case of an emergency
Name of Emergency Contact *
Your answer
Relationship to the Applicant? *
Your answer
Home Phone Number *
Your answer
Mobile Phone Number *
Your answer
Do you have any medical conditions that could be relevant? *
Required
Medical Conditions
Your answer
Are you taking any current medications that could be relevant? *
Required
Medications
Your answer
Do you have any allergies that could be relevant? *
Required
Allergies
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Do you have any personal needs or requirements that may be relevant? *
Required
Personal needs
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Parental Consent Form
A parental consent form is required for all members under the age of 18 years old.
I give my permission for...
Your answer
to become a member of Llanrwst Canoe Club and I accept that Llanrwst Canoe Club will not be held responsible for any injury or loss of equipment incurred during activities organised by the club. I also give permission for my child to take part in any activity organised by the club. In the event of an accident I give permission to any committee member of the club or any responsible adult to get any medical attention needed.
I give permission for photographs to be shown of my child on the Club Website
Please enter the e-mail address of your parent/guardian (If applicable). An e-mail will be sent to them to ensure they confirm the above details.
Your answer
Professional Membership
Are you a member of Canoe Wales / British Canoe Union? *
Required
Membership Number
Your answer
Llanrwst Canoe Club is affiliated to Canoe Wales, our national governing body.
Due to the new laws on data protection, and the change within the administration of Canoe Wales, we have to add your details to their database for you to be registered and covered by their insurance.
Once uploaded you will be sent a welcome email from Canoe Wales. You will have access to your data on their “GoMembership” web portal, and will be able to alter/amend/remove any data you so wish.
If you are already a member of Canoe Wales, then you will be able to upload your own data, and link it to our club through the new “GoMembership” portal at Canoe Wales
Thank you for your application. It will be discussed at the next committee meeting and the Membership Secretary will inform you of the outcome.
To contact the Membership Secretary email - membership@llanrwstcanoeclub.org.uk
‘CANOEING & KAYAKING ARE “ASSUMED RISK” - “WATER CONTACT SPORTS” THAT MAY CARRY ATTENDANT RISKS. PARTICIPANTS MUST BE AWARE OF & ACCEPT THESE RISKS & BE RESPONSIBLE FOR THEIR OWN ACTIONS & INVOLVEMENT’.

PARTICIPANTS MUST BE ABLE TO SWIM A WIDTH OF LLANRWST POOL CONFIDENTLY.

LLANRWST CANOE CLUB HAS A CHILD PROTECTION POLICY “ADULTS WITH REGULAR CONTACT WITH YOUNG PERSONS MAY BE ASKED TO UNDERGO A DBS DISCLOSURE”.
By submitting this application form, the applicant or guardian upon completion agree to the terms set out above.
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