Rutland Canoe Club Membership Form 2018/19
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 *
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Landline Phone *
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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)
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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 preferred method, Lloyds Bank Plc, sort code 30-98-90 account number 17250868, account in the name of "Rutland Canoe Club". Cheques to the Treasurer are also acceptable.
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Kayak Stars (fill in qualification and expiry date below)
Your answer
Canoe Stars Stars (fill in qualification and expiry date below)
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First Aid Qualifications (fill in qualification and expiry date below)
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Coaching Qualifications (fill in qualifications and expiry date below)
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Emergency Contact Name *
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Emergency Contact Number *
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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
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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.It is the responsibility of all members that if they have a critical medical condition that requires medication that they A) carry any required medication, B) inform the MBL or Trip Leader prior to launching and C) make the MBL or Trip Leader aware of where to locate the medication in case of emergency.
Information shared with Anglian Water at Whitwell *
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