Longridge canoe club

marathon & sprint racing

Longridge Canoe Club Quarry Wood Road Marlow, Bucks If you are under 16, please also ask your parent or carer to sign the form before it is returned. UK We will also use the information to ensure that you are kept informed about club events. SL7 1RE N.B. Telephone number and email should be that of parent or carer for those under 16. Phone: 01628 566196 www.longridgecanoeclub.org

Olympic go paddling

Name: Address: Town Postcode: Home phone: Mobile: Email: Date of birth

Person to Notify in Case of Emergency

Name (1): Address: Town: Postalcode: Home phone: Work phone: Mobile phone: Relationship: 1pm to 3pm Name (2): Address: Town: Postalcode: Home phone: Work phone: Mobile phone: Relationship:

Olympic go paddling
Date 10am to 12 noon

28 July

29 July 30 July 20 August 21 August

10.00 for each 2 hour session Paddle power level 1 certificate achievable in one session and is free. Paddle power log book costs 2.50 Medical notes:

Ethnicity

Disability

All information on this form is held with the strictest confidentiality. Longridge Canoe Club cannot be held responsible for any illnesses or injury incurred during or as part of participation with any junior coaching courses. We also reserve the right to cancel any of the dates and times due to poor weather or lack of participants. By returning this completed form, I agree to my son / daughter / child in my care taking part in the activities of Longridge Canoe Club. I understand I will be kept informed of these activities, for example timing and any transport details. I understand in the event of injury or illness all reasonable steps will be taken to contact me, and to deal with the injury / illness appropriately.

Name of parent / carer

Date: