Name………………………………………………….. Date of birth………………………..
Address………………………………………………. Canoeing qualifications
Town………………………………………………….. ……………………………………
County………………………………………………… Coaching qualifications
Postcode…………………………………………….. …………………………………..
Telephone…………………………………………… BCU / Scouts Membership number
Mobile ……………………………………………….. …………………………………..
Email……………………………………………………………….. Other relevant qualifications
…………………………………….
The Club uses email as a means of distributing news and information to members. Information held
by the Club will be used only by the Club for Club purposes. If you do not wish to receive Club emails
please circle as appropriate …. Y / N
Membership type: Adult / Junior (circle as appropriate)
Amount paid: £ Date:……………………………………..
Declaration
I understand that if my application is accepted, I must abide by the KSCC Code of
Conduct, which may be seen on the Club website (kingstonscoutscc.org.uk). Canoeing is an
assumed risk sport and while every care will be taken, the Club can in no way be liable for any loss,
damage or injury I may sustain during a Club organised event. I understand that photographs may be
taken during Club events and may be used for training or publicity. If a medical condition or
disability exists that may jeopardise safe participation in Club activities, it must be stated on this
form though this will not necessarily preclude membership or paddling.
Please state relevant medical or other conditions:
Signature:……………………………………………………………Date:………………………
(Parent if under 18)
Name of Parent / Guardian……………………………………………………………………
Consent form completed Y / N (circle as appropriate)
Consent forms, downloadable from website, are required for all under 18 for pool and trips.
Please check the Club website (kingstonscoutscc.org.uk) for latest information on Club activities.
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