New Membership Application Form
Personal Information
First name *
Your answer
Surname *
Your answer
I Like to be known as (nickname)
Your answer
Address *
Your answer
Suburb *
Your answer
State *
Postcode *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Phone number *
Your answer
Email address *
Your answer
Occupation
Your answer
Emergency Contact Information
In the event of an incident during a session the following person should be contacted (for paddlers aged under 18 this must be a parent or principal carer) - this person should be someone that will not be in the boat:
Name *
Your answer
Phone number *
Your answer
Email
Your answer
Relationship to me *
Your answer
Health and Fitness
I have the following medical information which should be known by the session leaders:
Condition
Your answer
Which is managed by
Your answer
I confirm that I can swim at least 50 metres in my paddling clothing, without a flotation device *
I have been dragon boating before my application to join YRD *
If yes, please give details of your prior experience. If you were a member of another club please include the club's names and when you were an active member. Please note we may contact the club for a reference check.
Your answer
What do you want to achieve from the sport and from YRD? *
e.g. fitness, competition, meet new people
Your answer
Details of any relevant qualifications (e.g. first aid, coaching, accredited sweep level)
Your answer
By submitting this form, I declare that the above information is correct to the best of my knowledge
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms