Whakatū Marae Waka-Ama Club

Whakatū Waka-Ama Club Membership Form October 2016 – September 2017

Please provide and attach a ‘head-shot’ photo and a scanned copy of formal I.D

MEMBER DETAILS EMERGENCY CONTACT Full Name: Full Name:

Gender (please circle): F / M D.O.B: Relationship: Address: Address: City: Postcode: City: Postcode: Contact Phone: Mobile: Email: Mobile: GENERAL INFORMATION – Please circle the options that apply to you below Swimming Ability: BEGINNER CAN SWIM COMPETENT Waka-Ama Experience: NONE SOME KNOWLEDGE TO SHARE CAN STEER Paddling Options: SOCIAL COMPETITIVE Preferred Paddling Time/s: MORNING AFTERNOON EVENING Significant Health Information:

BOOKINGS AND ENQUIRIES

Bookings and enquiries through Huriana Lawrence: Call 027 6633 083 or www.whakatumaraewakaamaclub.com Risk Analysis and Management System

Risks (Potential losses) 1. Capsized waka 2. Unknown medical condition 3. Knocked unconscious by Ama 4. Slipping on ramp 5. Ramp and car park traffic 6. Gear failure 7. Cutting feet on rocks 8. Cannot recover from trip 9. Hypothermia

Casual Factors Risk Reduction Strategies People Possible inexperience of Paddlers Experienced Instructor . Skill 1. Waka tipping, cannot recovery Session checklist of all ailments/medication of Paddlers . 1:5 ratio Paddlers to experienced Kaihoe Attitude 2. Medical condition (asthma attack etc.) 3. Knocked unconscious by Ama . Paddlers to wear polypropylene tops Age 4. Panic in the water . Paddlers to wear footwear down when running on road. Fitness 5. Wearing no footwear, cut feet) . Paddlers sessions to be conducted within harbour limits Ratio 6. Slippery ramp . All waka to carry emergency kit in storage Experience . Swimming competency test throughout course. Health . Dry tipping drill before going on water. . Life saving training (current first aid) . All Paddlers to wear PFD’s Equipment Clothing Shelter Bailer lost when tipping Sign off Safety Check pre-session by Instructor Transport Activity, Ama coming undone or knocked off Carry extra lashing Specific Gear Safety

Environment Rough or Cold Weather Paddling session to be conducted within harbour limits Weather . 25 knot ceiling on wind strengths to abandon the session Terrain Water Season Emergency Action Plan and Safety Guidelines

Emergency Procedure to manage each identified risk Emergency Gear required

1. Instructor to assess the situation, check each paddler is ok. 1. PDF for each paddler 2. Instructor to talk Paddlers through the up righting of a waka. 2. Charged cell phone/communication device 3. Instructor to give first aid assistance and set off flare and / or call 111. 4. Instructor to recover Paddler in the water recovery position and await assistance of 3. First Aid / Tow Rope the safety boat. 4. Bailers 5. Safety boat to take the person to the medical centre for attention if needed. 6. Instructor to guide capable paddlers to shore. 5. Spare Hoe 7. Instructor to check waka for any damages once on shore. 6. Flares / Spare Lashings Full8. NameInstructor (please to fill out print) an incident: form and contact club captain. Signed: Date:

REGISTERING MEMBERS ONLY

Have completed and signed off Safety Rules and Procedures (please circle) Yes / No

ANNUAL FEE

18YRS AND OVER $40 Every member of the club is registered with the National body, ‘Waka Ama NZ’ UNDER 18YRS $30 The fee for this registration is covered in the ‘Annual Fee’.

We do not take cash so please deposit payments directly into the Club Account with your name as the Reference

Whakatū Waka Ama Payment Deposit Date:

ASB - Nelson Branch Signed: Date:

123165 0399770 00 Parents Signature (if under 18yrs old):

CONDITIONS OF MEMBERSHIP

1. Each member commits to supporting club fundraising activities 2. Member information collected by the Whakatū Marae Waka-Ama Club can be shared with the NZ Waka Ama Association and other significant waka ama entities that are directly involved with the Whakatū Marae Waka-Ama Club. Each member is entitled to view and/or correct information held about them. 3. Each member consents to receiving electronic messages and information regarding the Whakatū Marae Waka-Ama Club or any other products, service or promotions offered by the Whakatū Marae Waka-Ama Club and agree that the person sending any such message need not include an unsubscribe facility in the message. 4. Each member agrees to abide by the club’s safety rules, which includes wearing a lifejacket if you are not a confident swimmer or as directed by the accompanying Steerer. 5. Each member understands that failure to comply with the Whakatū Marae Waka-Ama Club’s operating guidelines could result in termination of their membership. 6. DISCLAIMER: While taking all possible safety precautions, Whakatū Marae Waka-Ama Club will not be held liable for any personal injury/harm to paddlers at any time.

Full Name (please print): Signed: Date: