Thameswey Canoe Club Membership Form

Induction Course Date 1: Date 2:

This form needs to be completed by anyone paddling with Thameswey Canoe Club. You will receive free temporary membership to the club for the two induction course sessions. After this, if you wish to continue with the club you will need to join by paying the appropriate fee (see overleaf). Please complete this form using BLOCK CAPITALS NAME: ADDRESS: DATE OF BIRTH: TELEPHONE NO HOME: MOBILE: EMAIL: SEX: M/F MEDICAL Known medical conditions: Emergency Instructions: RELATIONSHIP: TELEPHONE NO: Family Doctor: Doctor Telephone:

POSTCODE: EMERGENCY CONTACT DETAILS: NAME:

QUALIFICATIONS: Canoeing Qualifications and Experience (Please give highest level in each discipline and date when achieved) DISCIPLINE KAYAK CANOE SEA SURF SAFETY FIRST AID KAYAK COACH CANOE COACH ASSESSOR OTHER LEVEL OR QUALIFICATION DATE

TCC Membership Secretary, Paul Hedges, 19 Brooke Road, Cirencester, Gloucestershire. GL7 1SX Tel. 01285 640432 / 07595 070677, email – paulb.hedges@sky.com

Thameswey Canoe Club Membership Form
CONSENT, PLEASE READ CAREFULLY:
• •

Induction Course Date 1: Date 2:

I have read the Thameswey leaflet and I agree to take part in the club activities under the supervision of a group leader I agree to abide by the rules and constitution of the Thameswey Canoe Club and to act in the best interests of the Club and the sport of canoeing/kayaking

I confirm that I (my child) have (has) no medical conditions other than those stated above and will inform the membership secretary if this should change

• • •

I consent to medical treatment for myself/my child if advised by a medical practitioner, and I am unable to consent at the time I agree to be at the pick-up/drop-off points for trips at the agreed times I understand that the Club or organisers accept no responsibility for loss, damage or injury caused by or during attendance of any of the club’s organised activities except where it can be shown to result directly from the negligence of the Club or Organisers

• •

I agree to abide by the code and conduct of Thameswey Canoe Club at all times We sometimes post photographs of club events on our website and on notice-boards at the Lake or at Milton Road Pool. Please delete below to indicate your decision:

I do / I do not give permission for photos of myself / my child to be used by Thameswey
Canoe Club for publicity of the club.

Signature …………………………………

Date……………………..

Countersignature of parent or guardian of person under 18yrs old Signature …………………………Print Name…………………. Date………… _______________________________________________________________________________ MEMBERSHIP TYPE (please tick) A ‘child’ is a member aged under 18yrs old.
If you are a BCU member please provide your membership number here: _______________. If you do not have a BCU membership number please join as NON-BCU.

ADULT BCU CHILD BCU ADULT NON-BCU CHILD NON-BCU OVER 65S UNEMPLOYED BOAT STORAGE

£12.00 £ 6.00 £17.00 £ 7.00 £ 7.00 £ 7.00 £15.00

FAMILY BCU FIRST ADULT FAMILY BCU EXTRA ADULT FAMILY BCU CHILD FAMILY NON-BCU FIRST ADULT FAMILY NON-BCU EXTRA ADULT FAMILY NON-BCU CHILD

£12.00 £ 8.00 £ 6.00 £17.00 £ 9.00 £ 7.00

**If you store a boat in the club stores at lake 12 please note that the storage fees are due at the same time as your club membership.**

Please send this form and a cheque payable to Thameswey Canoe Club to: TCC Membership Secretary, 19 Brooke Road, Cirencester, Gloucestershire. GL7 1SX
TCC Membership Secretary, Paul Hedges, 19 Brooke Road, Cirencester, Gloucestershire. GL7 1SX Tel. 01285 640432 / 07595 070677, email – paulb.hedges@sky.com