Annual Membership

Rowing, Sculling & Coxing Consent Form for new members and Learn to Row courses

(Please use one form for each applicant)

Name:_____________________________________________________________________________________

Adult / Child (U18)

Date of application:________________________________________________________________________________

Type of membership (annual junior/ adult/ L2R etc)____________________________________

I hearby declare that (name)__________________________________

DoB_______________  School year (if junior)______________

School (if junior)__________________________________________________

IS / IS NOT able to confidently swim at least 50m in light clothing.

and DOES / DOES NOT have a known medical condition that MAY inhibit their ability to row and train on and off the water (if does, please give details below)

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________ (continue overleaf if necessary)

Where a member/ L2R candidate is unable to confidently swim 50m in light clothing, they WILL still be allowed on the water, but only in benign conditions as decided by the duty safety officer/ coach and in a boat where they are able to wear a buoyancy aid that will not inhibit their sculling or coxing.

I understand that every care will be taken by all coaches to provide the safest environment possible but appreciate that rowing is a potentially dangerous sport.

My child and I have read and agree with the Thames Scullers anti-bullying policy and code of conduct Available on request.

and have made ourselves familiar with the Thames Scullers Water Safety and Risk Assessments. Available on request.

I have read and understand this form and I am happy/ for my child to take part.

Signed: (print name)________________________________

Relationship to minor if applicable:_______________________________

Emergency contact number:__________________________

Email address:______________________________________

Home address:____________________________________________________________________________________

I DO / DO NOT consent to my/ my child’s photograph being taken.

I DO / DO NOT consent to my email address being stored whilst my/ my child is a club member (or for the duration of learn to row)

I HAVE/ HAVE NOT PAID (Please use surname as reference on banking). Memberships are not valid until payment has been received

Annual club membership entitles the membership holder to 12 months membership of Thames Scullers from the start date. Should the membership holder wish to leave, the membership fee for the whole 12 months from start date remains payable.

Thames Scullers bank details 30-98-97 71100368

Please copy, paste and fill in this form and email to thamesscullers@gmail.com