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Glam Boaters Online Membership Form  
Name:
Date of Birth
Address
Email Address:
Contact Number
Mobile Number
This Information will be treated as confidential
It is important that you list any medical conditions that you have so trip and coaching leaders are aware of the conditions. It is your responsibility to disclose any conditions that you suffer from and any medication you require to trip leaders before arranging to participate.
Medical Conditions
Doctors Name
Doctors Address
Next of Kin
Tel No.
Next of Kin Address
Paddling Information Please list below any paddling qualifications and experiance you have
CW / BCU Qualifications
CW Membership Number
First Aid Qualifications
Paddling Experience
What Type of Paddling Interests You?

Surf      Freestyle   Sea Touring   River Running
Lakes    Slalom      Coaching      Pool
Summer Winter      Socials         Courses
Other
Are you able to help with any of the following Coaching        Committee Trip Planning Socials
Trip Transport Advertising Club Sponsorship
Boat Storage
I understand that paddle sport is an assumed risk water sport; I understand the risks involved with paddle sports and accept that I participate at my own risk at all times. I agree to inform the leaders of any condition or disability that affects me before participating in club activity and agree that it is my responsibility to carry and provide any necessary medication. I agree to abide by the rules of the club and that of Canoe Wales.
May we use you/your childs image in kayaking promotional publications such as the news letter or web page? Yes No
Sign Signed
Date
Parent or Guardian Name
Relationship
Parent or Guardian Signed

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