Welsh 09 Canoe and Kayak Show

Registration and Medical Consent Form

Personal Information:
Name *
Date of Birth *
Address *
Postcode *
Telephone *
Email *

Emergency Contact Information (Next of Kin):
Name *
Telephone *

Doctor:
Name
Telephone
Address

Additional Information:
Do you have any medical issues that may affect your participation? (e.g. asthma, diabetes etc) If yes, please provide details below:
 
 
Have you canoed or kayaked before?
 
Would you like to be contacted by email with canoe and kayak information by the Welsh Canoe and Kayak Show and Up and Under Watersports
 
What club do you belong to?
 
  • I agree to take part in the activities that are offered. Any medical conditions that I believe would affect me are listed above.
  • I understand that while all efforts have been made to cover my safety I am aware that canoeing / kayaking / sit on top kayaking can be a hazardous activity and that sometimes bumps, scrapes, accidents and even death can occur.
  • Members of Welsh Canoe and Kayak Show and Up and Under including their staff / any company representatives cannot be held responsible for any personal injury suffered.
  • Up and Under accept no responsibility for damage to or loss of any personal equipment on the event site or in use.
  • I am aware that there is a risk that I can get wet whilst taking part and I have got a dry set of clothes with me and that changing facilities have been made available to me.
  • I cannot hold the organisers responsible for my clothing or my person becoming wet.
  • In the event of an illness or an accident that results in emergency hospital treatment I give permission for the qualified coach to sign any consent form that the doctor / surgeon advise given due recourse to this form and the attempted contacting of next of kin and doctors.
  • I give consent under the Date Protection Act for any images depicting the participants named on this form to be used by Up and Under outdoor gear Ltd. The copyrights of the images will rest with Up and Under outdoor gear Ltd.
  • If under 18 years of age a parent / guardian must sign acceptance of the above conditions.
Submit