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.