UpperThamesRowingClubRemenhamLane,Remenham,BerkshireRG93DBTel: 01491 575745

Parental/Career’sJuniorConsentForm–2015/2016

Weare verypleasedtowelcomeallunder18’stoUpper ThamesRowingClub asjuniormembers.Juniormembersshallbe rowingmembersrestrictedto thosememberswho are under theage of18 yearsatthe timeof theconfirmationoftheirapplication or re-application.

Pleasecompletetheinformationrequested onboththis formand the membershiprenewal form.Thesedetailswillbe heldon computerfor thesoleuse ofthe Club.

Part ofmanagingtherisk is gatheringinformationonhealthandswimmingproficiency. Thisinformationis confidentialbut importantto ensureyourchild’swelfareasa participant.Our clubfollowsthenationalbodyguidelinesthatallcoachesandassistants arequalifiedfortheactivitiestheycontrolincludingsafety awareness. Participantswillneedtoparticipatein aswimtestandmustcompletea capsizeproceduretobeacceptedas members of theclub.

Pleaseprovidethepersonalinformationbelow, asitis importantwehaveyourcorrectcontactdetails.

PersonalDetails:(pleasecompletein blockcapitals)

Junior’sName: ……………………………………………………………………………Date of Birth……………………………...Parent/Career’sName (s)………………………………………………………………………………………………………………..Parent/Career’sAddress…………………………………………………………………………………………………………………

……………………………………………………………………………………………………Postcode……………………………Parent/Carer’sPhonesHome………………………………Work……………………………Mobile……………………………

Parent/Career’sEmail…………………………………………………………………………………………………………………….

Intheeventofanincident/accident:

EmergencyContactName…………………………………………………EmergencyNo.………………………………………...Rowingactivitieson thewaterand itsassociatedtrainingcanbe performedsafelyif wemanagetherisks.

Declaration ofHealthand SwimmingAbility:(delete ‘Yes’or ‘No’asappropriate)

Doesyourchildhave anyspecialneedthatourcoaches shouldknowabout?yes/ noDoesyourchildsufferfromany knownmedical or physicalconditionsthatmightaffectthem duringphysicalexercise

yes/ no

If theanswer isyes to either of theabovepleasegivedetails ona separatesheet of paper:

If youhaveansweredyesabove does thisprecludeheavyexercise?

(if indoubtyoushouldfirstconsulta doctor)yes/ no

Can yourchildswim100metersinlightclothing?yes/ no

Consent:

  • I agreetomychildtakingpartin theactivitiesofthe Clubandunderstandthat I willbekeptinformed oftheseactivities –egtimingandtransportdetails.
  • I willabidebytherules of theclub.
  • I willprovidetheparticipantwithappropriateand asparechange ofclothingforeachtrainingsession.
  • I understandthatin theeventof anyinjuryorillnessallreasonablestepswill betakentocontactme,andhavingparentalresponsibility fortheabovechild,I givepermissionforfirstaid tobe administeredor, whereconsiderednecessary,treatment byasuitablyqualifiedmedicalpractitioner.
  • If I cannot becontactedandmychildshouldrequireemergencyhospital treatment,I authorizea qualifiedmedicalpractitionertoprovideemergencytreatment ormedication.
  • I agreeformychildto bephotographedand/orvideoedaspart of thecoachingprocess.

Anychange in eithermedicalcircumstances or homeoremergencycontactdetailsshouldbenotified to theMembershipSecretary and Welfare Officer (See Club web site).

Parent/Career’ssignature………………………………………….Junior’ssignature………………………………………………..Print Name………………………………………………………….PrintName……………………………………………………Date…………………………………………………………………Date………………………………………………………………