Temporary Membership Application Form

Beginners/newcomers can have 3 Intro Sessions to be paid by BACS before the 1st session £5 a session or £10 for all three after which membership is required to meet our insurance requirements.

Basic Information

Name *

Email Address *

Mobile Phone *

Address (Line 1) *

Address (Line 2)

City / Town

Postal Code

Date of Birth *

Emergency Contact

Name *

Emergency Phone Number *

Address (Line 1) *

Address (Line 2)

City / Town

Postal Code

Relationship *

Watersports Readiness

Has your GP ever said that you have a heart condition and that you should only do physical activity recommended by him or her? *YesNo

Do you feel pain in your chest when undertaking physical activity? *YesNo

In the past month, have you had a chest pain when you were not undertaking physical activity? *YesNo

Do you lose you balance because of dizziness or do you ever lose consciousness? *YesNo

Do you have a bone or joint problem that could be made worse by a change in you physical activity *YesNo

Please give details

Are you pregnant or have you had a baby in the last 6 months? *YesNo

Is you GP prescribing drugs (for example water pills) for your blood pressure or a heart condition? *YesNo

Do you know of any other reason why you should not exercise? *YesNo

Please tick the box to confirm that you can swim 50m+ *

Club Rules

Please tick the box to show your agreement to these rules: *Respect – Treat other members and public as you would expect to be treated regardless of age, gender, ethnicity or ability. Consideration – Show consideration and avoid causing offence through language or actions which may bring the club or the sport into disrepute. Safety first – Always adopt a safety first attitude. Look out for yourself and your fellow rowers. Follow instructions during launch, rowing and recovery.

Digital Signature

Digital Signature *I confirm that I have read, understood and completed this questionnaire. I understand that I am voluntarily engaging in an acceptable level of exercise and my participation involves a risk of injury. By typing my name here am confirming that I have signed this form electronically.