Rutland Canoe Club Membership Form 2017/18
Rutland Canoe Club @ Flamborough Head 2015
Surname
Your answer
Christian Name
Your answer
BCU Membership Number
If Applicable
Your answer
Address
Your answer
E-Mail
Your answer
Landline Phone
Your answer
Mobile
Your answer
No Text Messages on Mobile
Required
Membership Required
Senior £85, Junior with Parent £46, Junior un-accompanied £85
Required
Date of Birth (for juniors)
Your answer
Amount Paid (please enter amount and method of payment)
Senior £85, Junior with Parent £46, Junior un-accompanied £85 or Half these amounts for September Joining. £3 discout for BCU Members, BACs payment to the following account is the preffered method, Norwich & Peterborough Building Society, sort code 40-65-00, account number 31370286, account in the name of "Rutland Canoe Club". Cheques to the Treasurer are also acceptable.
Your answer
Kayak Stars (fill in qualification and expiry date below)
Your answer
Canoe Stars Stars (fill in qualification and expiry date below)
Your answer
First Aid Qualifications (fill in qualification and expiry date below)
Your answer
Coaching Qualifications (fill in qualifications and expiry date below)
Your answer
Emergency Contact Name
Your answer
Emergency Contact Number
Your answer
Declaration (please re-enter name)
The following declaration must be signed by all Members. In the event of the Member being under 18 years old the declaration must be signed by their parent or guardian. As a member of Rutland Canoe Club I have read and agree to abide by the rules of the Club and I understand that canoeing is undertaken at my own risk. I confirm that I do not suffer from any disability or medical condition which may render me unfit for strenuous exercise.* I further undertake to advise the Club of any changes in risk during the year. By entering my name this represents acceptance of the rules and conditions of the club
Your answer
Medical Conditions (please tick if you have notified the committee of any condition)
*Should a medical condition exist, this will not necessarily preclude you from membership / participation, but it must be declared. Should you be in any doubt, advice should be sought from your family doctor
Information shared with Anglian Water at Whitwell
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms