BCU GBR FREESTYLE TEAM CONSENT FORM

Two copies of this form should be signed and returned to the team manager.

One copy will be kept by the team manager and a copy left with a committee official.

Name: ………………………………………………………………………………………………….

Date of birth: …………………………………………………………………………………………..

Next of kin: …………………………………………………………………………………………….

Address. Please give your next of kin’s home address and contact numbers. If they will be away from home during any trip/training weekend please give an alternative address where you, or a relative or friend for them can be contacted.

ADDRESS: …………………………………………………………………………………………………………..

………………………………………………………Post code: ………………………………………..

Tel (day) …………………………………………… (eve) ……………………………………………..

Email …………………………………………………………………………………………………….

ALTERNATIVE CONTACT NAME & ADDRESS:

…………………………………………………..

·  ………………………………………………………Post code:…………………………………

Tel (day) …………………………………………… (eve) ……………………………………………..

Mobile: …………………………………………………………………………………………………..

Doctor: …………………………………………………………………………………………………..

Doctors tel no: …………………………………………………………………………………………..

In your interest, it is important that the organising staff should know whether you suffer from any illness or medical condition. Please use a separate sheet to state in confidence any health or other matter concerning yourself which accompanying staff members should be aware. Please also indicate if you are receiving any medication, with details, dosage and/or dietary requirements. A certificate of use will be required from your GP for any prescription medicines.

CONSENT, PLEASE READ CAREFULLY:

·  I know that the risks and hazards of white water paddling and ensure that I have the necessary ability and experience.

·  I confirm to the best of my knowledge that I do not suffer from any medical condition other than those listed.

·  I consent to receive medical treatment which, in the opinion of a qualified medical practitioner, may be necessary.

·  I confirm that I am not subject to a court order prohibiting publication of my image.

·  I understand that the Freestyle committee accept no responsibility for loss, damage or injury caused by or during attendance on any organised training or event except where such loss, damage or injury can be shown to result directly from the negligence of the Freestyle Committee.

·  I consent for images and pictures of myself to be used for the promotion of the team.

·  I agree to abide by the Freestyle Committee Code of Conduct at all times.

Signed: ………………………………………………………. Date: ………………………………..