Thameswey Training Booking Form

Course Start Date

Name DOB
Address GP Name
and
Address
Postcode Medical
Conditions
Telephone Emergency
Instructions
Mobile Relevant Qualifications (include dates)
Emergency Contact
Name:
Tel no:
Mobile:
Equipment Needs
I have the following equipment which I would prefer to use for the training sessions. Please tick as
required:
Kayak [ ] Open Canoe [ ] Paddle [ ] Kagoule [ ] Buoyancy Aid/ PFD [ ] Spray deck [ ]
Any other equipment, please give details

Personal Needs
Please tell us about anything that would help you to learn and enjoy this course

CONSENT, PLEASE READ CAREFULLY:

I have read the Thameswey leaflet and I agree to take part in the course 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 (if applicable) 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.
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 me / my child to be displayed on Thameswey Canoe Club
publicity (please delete as appropriate).

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

Countersignature of parent or guardian of person under 18yrs old.
Signature ……………………………………. Print Name ………………… Date…………………………
Please return form with cheque for course fees payable to Thameswey CC to Rachel Cawte,
Thameswey Canoe Club, 6 Bowling Green Crescent, Cirencester, GL7 2HA
Thameswey Start - £7 NB: All course fees include session, equipment and certificate fees.
One Star Passport - £40
Two Star Discover - £75
FS&RT - £33 (BCU member), £38 (non-BCU member)