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Membership Form Northampton Canoe and Kayak Club Name: Membership Application Form Date Due: Boatrack Due: Please use BLOCK CAPITALS, complete both sides and SIGN THE FORM Use for renewals only If renewing then please highlight any change of detail e.g. address, phone, e-mail etc Full Name____________________________________________________________________________________________________________________________ Address______________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ Post Code ____________________ E-Mail Address _______________________________________________________________________________ Telephone Number ________________________________ Mobile Number ___________________________________________ Date of birth (U/18) __________________ Canoe England member? Y N If Yes tick type: Family Individual and give your Canoe England Number ____________ Please Supply a name and telephone number for a person who can be contacted in the event of an Emergency involving either you or a paddling member of your family – this will be made available to trip organisers and leaders. Name _______________________________________ Tel No (inc code) _______________________________________________ The club communicates with its members in a number of ways. Renewal notices and AGM notices are sent out by post and/or email. There are additional options. Please indicate whether you wish to allow each of them: Breakout magazine sent by post? Y N Breakout magazine sent by email? Y N A mailing list is used for general news, e.g. trips. Do you wish to take part? Y N A facebook group is used for general discuaaion amongst members. Do you wish to be invited to join? Y N We may wish to phone you for non-emergency messages. Do you want to allow this? Y N We may take photographs of our activities for publicity purposes. Are you willing to allow photos of yourself to be used? Y N If applying for Family membership then please complete the details below for each additional Family Member. Complete a second sheet if there are more than four additional Family Members. Additional details for each individual Additional details for each individual Name______________________________________________ Name______________________________________________ Date of birth (U/18)__________________________________ Date of birth (U/18)__________________________________ Mobile phone_______________________________________ Mobile phone_______________________________________ Email______________________________________________ Email______________________________________________ BCU member? Y N BCU member? Y N Will you allow: Breakout by email? Y Will you allow: Breakout by email? Y Mailing list? Y Mailing list? Y Facebook? Y Facebook? Y Phone calls? Y Phone calls? Y Photos? Y Photos? Y Additional details for each individual Additional details for each individual Name______________________________________________ Name______________________________________________ Date of birth (U/18)__________________________________ Date of birth (U/18)__________________________________ Mobile phone_______________________________________ Mobile phone_______________________________________ Email______________________________________________ Email______________________________________________ BCU member? Y N BCU member? Y N Will you allow: Breakout by email? Y Will you allow: Breakout by email? Y Mailing list? Y Mailing list? Y Facebook? Y Facebook? Y Phone calls? Y Phone calls? Y Photos? Y Photos? Y Adult Individual, Family and Student members are required to act as Duty Officer twice during their membership year. Duty Officer Preferences – please indicate your choices. I have no preferred days or dates I am unavailable for duties on Sundays Tuesdays (tick as appropriate) I would prefer to do my duties on any two of the following dates: ______________________________________________________________________________ _______________________________________________________________________________________________________________________________________ Do you hold any current qualifications in Paddlesport Coaching, First Aid or LifeSaving? Yes No Do you hold a DBS (CRB) clearance? ? Yes No If Yes then please give details: _____________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ Codes of Conduct :- The Club has adopted Codes of Conduct for the Club and its Paddlers, Junior Paddlers, Parents, Volunteers, Coaches and Officials. These are published on our web site, and stored within the ‘Health and Safety’ and ‘Clubmark’ files in the boathouse. Members are expected to acquaint themselves with the relevant codes and abide by them. Child Protection :- The club has a ‘Child and Vulnerable Adults’ Protection Policy which all members should acquaint themselves with and abide by. The policy is published on the Club notice boards as well as the web site, ‘Clubmark’ and ‘Health and Safety’ Files. Notes for Parents :- Supervision of club members off the water is limited. Members, including Junior members, must be responsible for the results of their own actions. Those who misbehave may be refused permission to join club events, or returned home early. If a child or vulnerable adult is left in the care of a club officer during a club session or trip then it is essential that a ‘Young Persons ’ form, giving contact and medical details, is completed and handed to that club officer. The form will be retained for seven years or until age 21. Chronic medical conditions e.g. Asthma, Diabetes, Epilepsy will not, in most circumstances, prevent an individual from paddling but, in the interests of safety, details of any such condition will be recorded and made available to trip organisers and leaders. Temporary medical conditions are not recorded and should be advised, together with any other medical concerns, to the trip organiser or leader at the commencement of the trip. Do you or a paddling member of your family suffer from any relevant long term illness? YES NO If Yes please provide details - including the name of the affected person. Canoeing and Kayaking are ‘Assumed Risk’ – ‘Water Contact’ sports that may carry attendant risks. Participants should be aware of and accept these risks, and be responsible for their own action and involvement. By signing this form you are accepting the above statement on your own behalf, and in the case of a family membership, on behalf of the members of your family. Check your Application Form has been fully completed and then sign below. Indicate the membership fee (less any discount) you are enclosing and return it together with your application to: NCKC membership, Nene Whitewater Centre, Bedford Road, N’pton NN4 7AA Membership Rates Per Year 1/2 Year (Trial) Payment Individual Membership * £65 £40 £__________ Junior Membership (U/18) £25 £15 £__________ Family Membership * £85 £50 £__________ Student Membership £40 £__________ Affiliated Membership Senior - £120 Junior - £80 £__________ * Individual and family members joining or renewing for a full year may deduct £5 if they are members of Canoe England and then a further Discount Claimed £___________ 10% discount for every completed 2 years of prior membership. Total Paid £___________ Please pay by BACS/Faster Payments to Lloyds Bank, sort code 30:96:26 Account no 31119960 with your name as the reference, or by cheque. Please make cheques payable to ‘ Northampton Canoe and Kayak Club’ I agree to abide by the rules of the Club and its Codes of Conduct Signed ________________________________________________ Date _____________________ (Parent or Guardian to sign also if the member is a Junior) .
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