Membership Application Form |

Clwb Canwio Llanrwst Canoe Club Application

Applicant Name *

Date of Birth *

Address *

Mobile Phone

Home Phone

Work Phone

Email *

CW / BCU Member? *

Yes No

If yes, membership number

Membership Type *

Household/Family Membership please note: Select the "Membership Type" for each applicant then contact the Treasurer for your discounted rates. Email - treasurer@llanrwstcanoeclub.org.uk

Do you intend to pay via BACS? *

First Contact in an Emergency *

Relationship to the Applicant?

Home Phone

Mobile Phone

Work Phone

Any medical conditions that could be relevant? *

Yes No

If yes, please list

Any current medications that could be relevant? *

Yes No

If yes, please list

Any allergies that could be relevant? *

Yes No

If yes, please list

Parental Consent Form For All Members Under 18 Years Old

I give my permission for (Applicants Name)

to become a member of Llanrwst Canoe Club and I accept that Llanrwst Canoe Club will not be held responsible for any injury or loss of equipment incurred during activities organised by the club. I also give permission for my child to take part in any activity organised by the club. In the event of an accident I give permission to any committee member of the club or any responsible adult to get any medical attention needed.

I give permission for photographs to be shown of my child on the Club Website

Yes No

Please enter the e-mail address of your parent/guardian (If applicable). An e-mail will be sent to them to ensure they confirm the above details.

Parent / Guardian E-mail

Thank you for your application. It will be discussed at the next committee meeting and the Membership Secretary will inform you of the outcome.
To contact the Membership Secretary email - membership@llanrwstcanoeclub.org.uk

‘CANOEING & KAYAKING ARE “ASSUMED RISK” - “WATER CONTACT SPORTS” THAT MAY CARRY ATTENDANT RISKS. PARTICIPANTS SHOULD BE AWARE OF & ACCEPT THESE RISKS & BE RESPONSIBLE FOR THEIR OWN ACTIONS & INVOLVEMENT’. LLANRWST CANOE CLUB HAS A CHILD PROTECTION POLICY “ADULTS WITH REGULAR CONTACT WITH YOUNG PERSONS MAY BE ASKED TO UNDERGO A DBS DISCLOSURE”.

Membership Application Form

Llanrwst Canoe Club

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