PARENTAL CONSENT / PADDLER INFORMATION FORM WEST

PARENTAL CONSENT / PADDLER INFORMATION FORM - TRIPS, TOURS AND EVENTS
Please fill this in fully, accurately and legibly – it will be vital in an emergency. Please read the conditions overleaf before you sign the second side.
Place of Event
Date of Event
Coach in Charge
Minimum level / ability for event
Name of Member
Canoe qualifications / experience
Address
Medical conditions / allergies
Home phone number
Phone number for
emergency contact
during event
Medicine supplied:
Date of last Tetanus jab:
Name and phone number
of Family Doctor
Please ensure any appropriate medication is supplied with paddler’s name and correct dosage marked. U18s to
hand medication to coach in charge on arrival.
Transport arrangements are the responsibility of the
individual. Peninsula Canoe Club will attempt to link
paddlers attending this event in order to share transport.
Under these circumstances transport remains the
responsibility of the paddler and their family. Please give
brief details of your transport arrangements including
(where known) the registration number of the car.
Medical Consent
I confirm that the above medication has been prescribed by a doctor and I give permission for the coach in
charge of the session, or their nominee, to administer the medicine and / or appropriate first aid to my son /
daughter/ ward/ myself * during the session.
* Delete as appropriate
Signed …………………………………….. ……… Paddler / Parent / Guardian
Date ……………….
PTO
Peninsula Canoe Club
Event Consent Form
April 2014
If you are bringing your own boat please give details of make and colour:
_____________________________________________
Is it named?
Please provide any other personal information about which you consider the Coach
should be made aware:
Y
N

I give my consent or I give consent for my son / daughter / ward, to participate in the Peninsula Canoe Club trip or event.

I have read the “RISKS INVOLVED” leaflet (issued with the Membership form) and I understand these risks and I am aware that I / my child / my ward participate
at my / their own risk. I understand that if I am in any doubt about the risks involved that I should contact, and have contacted, the organising coach to discuss them.

I understand that it is my responsibility to ensure that I am / my child / my ward is at the appropriate level of paddling ability for the proposed trip and that if I am
in any doubt about this I should contact, and have contacted, the organising coach to discuss the matter with him or her and confirm this point.

I understand that it is my responsibility to ensure that I / my child / my ward have / has the proper and correctly functioning equipment necessary for the event as
given on the EQUIPMENT LIST.

I understand that the Coach in charge has the right to refuse to allow me / my child / my ward, to participate if not properly equipped or if the Paddler Information
Form / Parental Consent Form is not fully and accurately filled in, or if their personal condition on the day deems them an unacceptable risk.

I understand that Peninsula Canoe Club cannot be held responsible for me /my child / my ward, or any of my or their equipment before or after the session itself.

I understand the transport arrangements for both persons and boats for this particular Peninsula Canoe Club organised event.

I understand that Peninsula Canoe Club is insured in respect of its legal liabilities only and that there is no personal accident or other cover. I will arrange for
Personal Accident Insurance if I consider it necessary.

I understand that if I / my child / my ward deviates from the event, as set out by the Coach in charge, in any way, I am / they are / no longer deemed to be a part of
the event, and, as such, are no longer covered by Peninsula Canoe Club rules or insurance, and that I / they will be asked to leave the event.

I am responsible for filling out this form accurately and legibly and including all details that might be needed by the Coach in charge. I am responsible for any errors
and omissions pertaining to personal information and accept liability for any direct or indirect consequences that might arise from these errors or omissions.

I understand the above statements and agree to them.
Signed _________________________________________________ Paddler / Parent / Guardian
Date _____________
Please print your name here __________________________________________________
Peninsula Canoe Club
Event Consent Form
April 2014