ADULT MEMBERSHIP REGISTRATION & DECLARATION FORM

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Please note that this is NOT confirmation of a booking on camp. A booking is ONLY complete once full payment has been recieved.

First Name *

Surname *

Course *

Taster Session

Learn to Row

Recreational

Race

Private Session

Home Address

Postcode

Age *

Date of Birth *

YYYY

Email Address *

Contact Number *

Primary Emergency Contact *

Secondary Emergency Contact

Occupation

Previous Rowing Experience *

Never Rowed Before

Rowed in Quad

Rowed in Double

Rowed in Single

Rowed in Eight, Sweep.

Required

Where to you want to take your rowing?

Keep fit & row recreationally

Row competitively

While at the boathouse & on the water you agree to follow the club safety rules. By signing this declaration you agree to adhere to the TKSS and British Rowing Code of Conduct at all times. *

Yes

Photos may be taken from time to time for advertising, use on our website or social media sites. Do you consent to this *

Yes

Medial and Personal Health. Rowing and its associated training can be a strenuous activity. By completing this declaration you are confirming that you are in good health and have no medical or physical condition which may precluding you from heavy exercise, if there is any doubt, consult your doctor before completing this declaration. You have a duty to declare any condition that might put yourself or others at risk at this time or any time in the future. *

You are fit to row according to the terms stated above

Required

Please list any condition & special requirements below. It is your duty to personally advise the Coach before your first session if there is any condition they should be aware of in the event of an emergency. i.e. asthma, diabetes etc.… You MUST bring any required medication to EVERY session. Without it you will not be allowed in the session. If none are required then please answer with 'nil'. *

Swimming Requirement: For safety, it is important that you are a competent swimmer. At a minimum, you must be able to swim 50 meters in light clothing. If you cannot meet this requirement, you must wear a buoyancy aid at all times when in a boat. It is your responsibility to request a life jacket at each session *

I can swim 50 meters in light clothing

I will require a buoyancy aid to row

Required

Declaration *

I have read and understand all of the conditions stated on this declaration and confirm that all the information I have added is correct & I understand that Team Keane will not be held responsible for any incorrect information I have added to the form.

Required

Date Completed *

YYYY

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