PADDLESPORT APPLICANT INFORMATION

First names

Surname

Date of Birth

Gender
MaleFemaleOtherPrefer not to say
Can you/applicant swim 50 Meters unaided
YesNo
Email if you wish to receive Club information:

Parent/Guardian Name if under 18

Parent/Guardian Releationship to Applicant if under 18

Parent/Guardian Telephone Number if under 18

Parent/Guardian Postcode if under 18

EMERGENCY CONTACT INFORMATION

(A CONTACT NOT PADDLING WITH APPLICANT WHEN TAKING PART IN CLUB ACTIVITIES)

Emergency Contact Name

Emergency Contact Relationship to Applicant

Emergency Contact Address & Postcode

Emergency Contact Mobile No:

DATA PROTECTION & MEDIA PUBLICATION

West Yorkshire Canoe Club (WYCC) may wish to take photographs/videos recordings of our members when taking part in club activities. These images may appear on social media or our club website.

The Taster Session Application Form (submitted electronically) will be securely held by the Club up to the 31st December (yearly) and then be destroyed/deleted. The same will apply to all electronically copied data. To assist the Club in its activities only, the information on the Taster Application Form will be shared with Club Coaches & the General Committee. Information will only be shared with Club Coaches & members of the General Committee with a current DBS check. No information will be shared with a third party without your consent and is strictly confidential.

All general club enquires must be sent to club.secretary@westyorkshirecanoeclub.com

All membership enquiries must be sent to membership@westyorkshirecanoeclub.com

All welfare & safeguarding enquiries must be sent to welfare@westyorkshirecanoeclub.com

You have the right to request any personal date held by the Club at any time and can ask for such information be destroyed, returned or deleted from Club records in part or as a whole. Please contact club.secretary@westyorkshirecanoeclub.com

To comply with the General Data Protection Regulation 2018, the Club requires your understanding & agreement of the above.
I accept the Data Protection Statement

PADDLESPORT DECLARATION

I understand that canoeing is an ‘assumed risk’, ‘water contact sport’ that may carry attendant risks. I am aware of and understand these risks and take responsibility for my own / sons / daughters actions and involvement.

The West Yorkshire Canoe Club operates within British Canoeing policies and guidelines and I / my son / my daughter agree to adhere to these guidelines.

I confirm I / my son / my daughter, do not suffer from any disability or medical condition that may render me unfit for strenuous activity including water sports

Should a disability or medical condition exist, this will not preclude you / your son / your daughter from membership or participation but it must be declared in the medical section (below). If you are in doubt, advice should be sought from your family doctor

I have had the activities explained and understand and agree to myself/ my son/ my daughter to participate in the activities / event.

I understand that the club/ organisers accept no responsibility for loss, damage or injury caused by or during attendance of the organised activity/event, except where such loss, damage or injury can be shown to result directly from the negligence of the club / organisers.

I confirm to the best of my knowledge that myself/ my son/ my daughter does not suffer from any medical condition other than those listed on the following section.

I understand that British Canoeing / West Yorkshire Canoe Club as an affiliated club is insured for its civil liabilities as organiser of the activities/events and that there is no personal accident cover for participants.

I am responsible for completing this form accurately and including all details that might be needed by the person in charge. I am responsible for any errors and omissions to personal information and accept liability for any direct or indirect consequences that might arise from these errors or omissions.

I confirm that my son/ daughter is not subject to any court order prohibiting publication of their image.

I consent to my son/ daughter travelling by any form of transport arranged or approved by the organisation and related to the specific activity /
event.

I agree to be at the pick-up/ drop-off point at the agreed time.

Paddlesport declaration - Click to confirm you have read and understand the paddlesport declaration above.

MEDICAL CONDITIONS / MEDICAL TREATMENT

It is important that WYCC/Organisers/Coaches should know whether you / your child suffer from any illness or
medical condition. Please use the space below to state in confidence any health or other matters concerning the applicant which we should be aware. Please also indicate if you/ your child is receiving any medication, with details and dosage, and/ or specific dietary requirements.

Does the applicant suffer from any of the following:

Asthma
YesNo

Epilepsy
YesNo

Diabetes
YesNo

Skin Conditions (e.g. Eczema)
YesNo

Recurring Headaches
YesNo

Other Medical Issues not listed above

If you answered yes to any of the above or there any other existing medical conditions please give details below:

Doctor Surgery Name

Doctors Surgery Telephone Number

Medical Treatment

If you/the applicant experiences any conditions requiring medical treatment and or medication, please provide details (such as Medication, Dosage, etc) below:

If you/the applicant experiences any conditions requiring medical treatment and/or medication, please provide details (such as Medication, Dosage, etc) below:

Please provide any other information we should know which could affect our ability to work with you/ the applicant effectively:

I consent to myself / my child receiving appropriate first aid or in a medical emergency consent to medical treatment
which, in the opinion of a qualified medical practitioner, may be necessary.
Please delete as necessary:
a) I give consent to ANY medical treatment to be provided in the event of an emergencyb) I give consent for any medical treatment to be provided EXCLUDING (Please specify below):

I confirm the applicant information, emergency contact details, inclusivity, medical consent, medical conditions are correct and I have read/understood the paddlesport declaration.

(Please check you have completed all applicable fields)