Model Membership Form printable pdf download

Membership Form

MODEL MEMBERSHIP FORM

Applicants NAME:

Applicants Address:

Telephone Number:

Home

Work

Mobile

E-MAIL Address

Category of

Adult / Junior / Family *

(Circle as appropriate)

Membership

Date of Birth

Gender

Male / Female.

* If the applicant is under the age of eighteen years at date of signing of the above

membership form a parent/guardian must sign this form also.

* Where family membership is requested the application form must be completed by each

participating family member, when the family member is under 18years at date of signing the

application form must be signed by a parent or guardian.

CLUB SAFETY STATEMENT

•

Never canoe alone

•

Do not canoe if you cannot swim.

•

Always wear adequate buoyancy and ensure there is adequate buoyancy for your

canoe.

DECLARATION

I accept that canoeing is an adventurous sport, which by its very nature is a sport that

involves a degree of risk of personal injury or death. I acknowledge that

<insert club name

here>

cannot ensure my complete safety at all times, I accept these risks and agree to be

responsible for my own actions and involvement. I accept that

cannot be held liable for any injuries caused to me or caused to others or their property by

me, due to my participation or involvement in this sport.

I confirm that I can swim at least twenty-five meters and am proficient in treading water.

The club committee reserve the right to refuse membership or in certain circumstances

terminate membership. The annual club membership runs each year from ______ to ______

Any person joining in mid term will be liable for the cost of the full annual term.

I confirm that I have read the above and I understand the conditions as set out therein.

Page 1 of 2

Model Membership Form