Learn to Row Application Form

Junior Learn to row course*18-30 Learn to row course*Adult Learn to row course*

Please confirm how you have made your payment*

—Please choose an option—Course Fee paid by bank transferCourse Fee paid by Cheque or cash

Date Payment made (format for all dates depends on your browser, any issues please try dd/mm/yyyy if you still have issues please try another browser or devise or speak to a committee member to help):

Amount Paid* £

First name*:

Last name*:

Address*: (please do not use commas, just spaces)

Town*:

Postcode*:

Email*:

Male*Female*Other*

Date of birth*:

EMERGENCY CONTACT - Provide details of the person to be contacted in case of an accident or emergency

Name*:

Telephone number*:

Alternative Telephone number:

Relationship:

MEDICAL OR ADDITIONAL REQUIREMENTS – Do you have any medical conditions, impairments, disabilities or do you require any additional support / special arrangements to take part in rowing? Some conditions such as asthma and diabetes or autism do not prevent individuals participating in the sport, but it is important that you inform the club of any condition that might put yourself or others at risk. All answers will be treated with confidence, this is balanced by the information being available when it is required to support your health and safety, please see the BRC Privacy Notice at the top of the page for more details. It will remain your responsibility to manage your condition, for example by carrying an asthma inhaler, an epipen etc. and by notifying relevant personnel (for example coaches or vice captain) including if your condition changes.
This information is essential to ensure safety of yourself and other members, if yes please detail:
YesNo

If yes please detail (please do not use commas, just spaces):

Medical condition or additional requirements (needs)

Indication / Symptom / Effect

Action to be taken in emergency / incident

PHOTOGRAPH CONSENT – Photos and video may be taken of members at the club and events the club attends, these may be used on the club website and social media e.g. Facebook and Twitter to help promote the achievements of the club and our members, or for coaching, we will follow best safeguarding practice. Please tick YES if you are happy to be included in photographs or videos, or if you do NOT want to be included in any photographs or video please tick NO and inform your course coach and crew members YesNo

Declaration - By applying to attend a course and/or participating in activities at the club you agree that you:

• Can swim 50 metres in light clothing (rowing kit), tread water for 2 minutes and swim underwater for 5m.

• Do not have any medical or physical condition precluding heavy exercise and will only participate in accordance with doctor’s advice. Some conditions such as asthma and diabetes or autism do not prevent individuals participating in the sport but you do have a duty to declare any condition that might put yourself or others at risk (complete the Medical or Additional Requirements above) and that if your state of health or contact details change you will inform the Club Captain (or Membership Secretary) or VC without delay.

• In the event of any injury or illness all reasonable steps will be taken to contact your emergency contact, you (or an individual with parental responsibility for a junior) give permission for first aid to be administered or where considered necessary, emergency treatment or medication by a suitably qualified medical practitioner.

• Accept that use of club equipment and facilities is entirely at your own risk and that you take responsibility for your own safety and ensure that your actions do not put others at risk (all both on and off the water).

• Have received a club induction and are aware of the Safety Notice board relating to emergency procedures & telephone numbers, capsize and recovery procedures and information on waterbourne diseases.

• Will abide by the Club Rules and By-Laws for Rowing (and Safety Plan) and of the rules of the sport of rowing at all times, including the British Rowing Code of Conduct and Rowsafe guidelines which can be accessed on our Membership page

(If under 18 years old acceptance to be by parent / guardian as well as the junior member)

Please click box to confirm you have read and accept the declaration*