Membership Form 2020
Please print off, complete in BLOCK CAPITALS as fully as possible and return by email or post or to any authorised BCHG member
Applicants Name: ______________________________
Gender: Male / Female
(Please circle as appropriate)
Date of Birth: ______________________________
Address: ______________________________
______________________________
______________________________
Contact Telephone No: ______________________________
Alternative Contact No: ______________________________
E-mail Address: ______________________________
Next of Kin (PRINT name and phone number):_______________________________________
_______________________________________
Medical History
Please give full details of any medical/ health conditions. If none, insert N/A.
____________________________________________________________________________
____________________________________________________________________________
Other Information
Please provide details of any other special needs, requirements or directions that may be helpful for Senior Trainers to be aware of or that may on occasion impact on your ability to undertake water based activities ie. Asthma, Epilepsy, Nut Allergy etc… If none, insert N/A.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
I ________________________, wish to apply to become a member of Boyne Currach
Heritage Group. I confirm that I have read and understand the information contained within
this form and I am aware that I will be participating in water based activities.
I hereby consent to participating in the activities of Boyne Currach Heritage Group. I will
inform an authorised member of any changes in the above-mentioned circumstances that
may affect my safe participation in activities and of any changes to the information provided
above. I accept that my failure to take instruction from a senior trainer may cause
immediate expulsion from BCHG and that no refunds are given.
I confirm that the information provided above is accurate.
I wish to be included on the Whats App Group to avail of information regarding relevant
events [ ] (Please tick)
Signed: ___________________________ Date: ________________________
Print Name: ___________________________
*****NOTE *****
If persons are under 18 years of age, parental/ guardian consent is needed (see below) and
they must be accompanied by guardian/ parent for on water activities
I, ___________________, give permission for my son/ daughter to apply for membership of Boyne
Currach Heritage Group.
Parent/ Gaurdian signature: _______________________________________________
The Boyne Currach Heritage Group will keep your details on file for the number of years
needed, personnel information can be destroyed upon request. Your details will only be used in order
to contact you with information regarding our group or information relating to other boating outings.
Your details may be required to be shared with our insurance companies.
Apart from the above stated purposes, your personal details will not be used or shared with any other
party, except in circumstances where this group is compelled to do so by the laws of the State.
--------------------------------------------------------------------------------------------------------------------------------------
My commitment to Boyne Currach Heritage Group
I ________________________, wish to participate in the sport of river and coastal paddling/ rowing
and I agree to follow the rules and procedures of Boyne Currach Heritage Group that have been
explained to me and I understand.
I am aware that the authorised members volunteer their personal time and are here to help me and
that if I am unsure of anything, I have the responsibility to ask. I further understand the importance
of listening to and acting on their instruction when entering the boat, on the water and exiting the
boat. I will ensure that I wear my life jacket at all times when I am on or near the water. The main
hazards/ risks of river paddling and coastal rowing have been explained to me and I have understood
them.
I will do everything in my power to ensure that I support my fellow crew and club members in a truly
positive manner at all times.
I am aware that all sports can have hidden dangers and I will take guidance and instruction from
senior trainers. I take full responsibility for my own safety at all times.
Singed: _________________________ Date: ________________________
Print Name: _________________________ €50 enclosed [ ] please tick
Gender: Male / Female
(Please circle as appropriate)
Date of Birth: ______________________________
Address: ______________________________
______________________________
______________________________
Contact Telephone No: ______________________________
Alternative Contact No: ______________________________
E-mail Address: ______________________________
Next of Kin (PRINT name and phone number):_______________________________________
_______________________________________
Medical History
Please give full details of any medical/ health conditions. If none, insert N/A.
____________________________________________________________________________
____________________________________________________________________________
Other Information
Please provide details of any other special needs, requirements or directions that may be helpful for Senior Trainers to be aware of or that may on occasion impact on your ability to undertake water based activities ie. Asthma, Epilepsy, Nut Allergy etc… If none, insert N/A.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
I ________________________, wish to apply to become a member of Boyne Currach
Heritage Group. I confirm that I have read and understand the information contained within
this form and I am aware that I will be participating in water based activities.
I hereby consent to participating in the activities of Boyne Currach Heritage Group. I will
inform an authorised member of any changes in the above-mentioned circumstances that
may affect my safe participation in activities and of any changes to the information provided
above. I accept that my failure to take instruction from a senior trainer may cause
immediate expulsion from BCHG and that no refunds are given.
I confirm that the information provided above is accurate.
I wish to be included on the Whats App Group to avail of information regarding relevant
events [ ] (Please tick)
Signed: ___________________________ Date: ________________________
Print Name: ___________________________
*****NOTE *****
If persons are under 18 years of age, parental/ guardian consent is needed (see below) and
they must be accompanied by guardian/ parent for on water activities
I, ___________________, give permission for my son/ daughter to apply for membership of Boyne
Currach Heritage Group.
Parent/ Gaurdian signature: _______________________________________________
The Boyne Currach Heritage Group will keep your details on file for the number of years
needed, personnel information can be destroyed upon request. Your details will only be used in order
to contact you with information regarding our group or information relating to other boating outings.
Your details may be required to be shared with our insurance companies.
Apart from the above stated purposes, your personal details will not be used or shared with any other
party, except in circumstances where this group is compelled to do so by the laws of the State.
--------------------------------------------------------------------------------------------------------------------------------------
My commitment to Boyne Currach Heritage Group
I ________________________, wish to participate in the sport of river and coastal paddling/ rowing
and I agree to follow the rules and procedures of Boyne Currach Heritage Group that have been
explained to me and I understand.
I am aware that the authorised members volunteer their personal time and are here to help me and
that if I am unsure of anything, I have the responsibility to ask. I further understand the importance
of listening to and acting on their instruction when entering the boat, on the water and exiting the
boat. I will ensure that I wear my life jacket at all times when I am on or near the water. The main
hazards/ risks of river paddling and coastal rowing have been explained to me and I have understood
them.
I will do everything in my power to ensure that I support my fellow crew and club members in a truly
positive manner at all times.
I am aware that all sports can have hidden dangers and I will take guidance and instruction from
senior trainers. I take full responsibility for my own safety at all times.
Singed: _________________________ Date: ________________________
Print Name: _________________________ €50 enclosed [ ] please tick
