Thameswey Canoe Club Induction Course

Date 1:
Membership Form Date 2:

This form needs to be completed by anyone paddling with Thameswey Canoe Club. You will receive
free temporary membership to the club for the two induction course sessions. After this, if you wish
to continue with the club you will need to join by paying the appropriate fee (see overleaf).

Please complete this form using BLOCK CAPITALS

NAME: DATE OF BIRTH:

ADDRESS: TELEPHONE NO HOME:

MOBILE:

EMAIL:
POSTCODE: SEX: M/F

EMERGENCY CONTACT DETAILS: MEDICAL

Known medical conditions:
NAME:
Emergency Instructions:
RELATIONSHIP:
Family Doctor:
Doctor Telephone:
TELEPHONE NO:

QUALIFICATIONS: Canoeing Qualifications and Experience (Please give highest level in each
discipline and date when achieved)

DISCIPLINE LEVEL OR QUALIFICATION DATE

KAYAK
CANOE
SEA
SURF
SAFETY
FIRST AID
KAYAK COACH
CANOE COACH
ASSESSOR
OTHER

TCC Membership Secretary, Paul Hedges, 19 Brooke Road, Cirencester, Gloucestershire. GL7 1SX
Tel. 01285 640432 / 07595 070677, email – paulb.hedges@sky.com
 Thameswey Canoe Club Induction Course
Date 1:
Membership Form Date 2:

CONSENT, PLEASE READ CAREFULLY:

• I have read the Thameswey leaflet and I agree to take part in the club activities under the supervision of a group leader

• I agree to abide by the rules and constitution of the Thameswey Canoe Club and to act in the best interests of the Club and
the sport of canoeing/kayaking

• I confirm that I (my child) have (has) no medical conditions other than those stated above and will inform the membership
secretary if this should change

• I consent to medical treatment for myself/my child if advised by a medical practitioner, and I am unable to consent at the time

• I agree to be at the pick-up/drop-off points for trips at the agreed times

• I understand that the Club or organisers accept no responsibility for loss, damage or injury caused by or during attendance of
any of the club’s organised activities except where it can be shown to result directly from the negligence of the Club or
Organisers

• I agree to abide by the code and conduct of Thameswey Canoe Club at all times

• We sometimes post photographs of club events on our website and on notice-boards at the Lake or at Milton Road
Pool. Please delete below to indicate your decision:

I do / I do not give permission for photos of myself / my child to be used by Thameswey

Canoe Club for publicity of the club.

Signature ………………………………… Date……………………..

Countersignature of parent or guardian of person under 18yrs old

Signature …………………………Print Name…………………. Date…………

_______________________________________________________________________________
MEMBERSHIP TYPE (please tick) A ‘child’ is a member aged under 18yrs old.

If you are a BCU member please provide your membership number here: _______________. If you do not have a BCU
membership number please join as NON-BCU.

ADULT BCU £12.00
FAMILY BCU FIRST ADULT £12.00

CHILD BCU £ 6.00
FAMILY BCU EXTRA ADULT £ 8.00

ADULT NON-BCU £17.00
FAMILY BCU CHILD £ 6.00

CHILD NON-BCU £ 7.00
FAMILY NON-BCU FIRST ADULT £17.00

OVER 65S £ 7.00
FAMILY NON-BCU EXTRA ADULT £ 9.00

UNEMPLOYED £ 7.00
FAMILY NON-BCU CHILD £ 7.00

BOAT STORAGE £15.00

**If you store a boat in the club stores at lake 12 please note that the storage fees are due at the same time as your club
membership.**
Please send this form and a cheque payable to Thameswey Canoe Club to:
TCC Membership Secretary, 19 Brooke Road, Cirencester, Gloucestershire. GL7 1SX

TCC Membership Secretary, Paul Hedges, 19 Brooke Road, Cirencester, Gloucestershire. GL7 1SX
Tel. 01285 640432 / 07595 070677, email – paulb.hedges@sky.com