HALIFAX CANOE CLUB
Membership 2017/18
I / We wish to apply for membership of Halifax Canoe Club
Title: Mr/Mrs/Miss /Ms Surname:
First Name (s):
Address:
Post Code:
Telephone No: Mobile No:
Email:
BC Number (if a member)
1a.Membership Required(Please tick the relevant box)
FULL MEMBERSHIP£47.50
JUNIOR (under 18)£35
FAMILYParents/Guardians & their Children (under 18)£77.50
Parents must sign disclaimer B as well as A
CONCESSIONS£35
(Long term unemployed and students 18+ in full time education)
1b. Every adult who is not a British Canoeing member must pay an additional £2.20 affiliation on top of the fees above.
2. Please state below the names and dates of birth of those to be covered by family membership:
Name
/ Date of Birth / Email(if over 16) / Mobile
(if over 16) / BC Number (if a member)
3. Please fill in the number of people covered by your membership application in each group
(this information is for the British Canoeing/ grant applications only total numbers are passed on)
British Canoeing members / Non British Canoeing membersAge category / Male / Female / Male / Female
Under 13
14-18
19 – 25
26-45
46+
Halifax Canoe Club, Greenups Mill, Wharfe Street, Sowerby Bridge, HX6 2AQ. Registered Company No. 2616775
Registered Company No. 2616775
4a. Disclaimer A
Canoeing and Kayaking are ‘assumed risk’ – ‘water contact sports’ that may carry attendant risks. Participants should be aware of and understand these risks, and be responsible for their own actions and involvement. Whilst every care is taken to ensure your safety during Club activities, Halifax Canoe Club is not responsible for your safety or for loss or damage to property or equipment belonging to any individual.
Data Protection: By signing this form I agree to information being held by Halifax Canoe Club and used for Club administration and to keep me informed of Club activities. The Club will not share your details with third parties without your permission.
Photography: I do/do not (delete as appropriate) consent to images of me/us participating in Halifax Canoe Club activities being used for club publicity, including on the Club’s website.
I have read and agree to the club policies on the website or in the yearbook
Signature of Applicant: Date:
Parents/guardians mustALSO sign the Disclaimer B below for paddlers under 18
4b. Disclaimer B
To be signed by the parent / guardian of family and youth members under 18
Whilst every care is taken to ensure your child’s safety during canoeing activities, Halifax Canoe Club is not responsible for your child. The child’s parent/guardian should be on the bank or in the vicinity of the activity. If there are any worries or questions these should be directed towards the coaches.
I ______being the parent/guardian of the child/children named as family members accept and understand that I am responsible for him/her/them when her/she/they are taking part in any canoeing activity/event organised or entered upon by the Halifax Canoe Club, including training and paddling on moving or placid water.
I agree that Halifax Canoe Club and its agents accept no responsibility for my child/children
I have read and agree to abide by the parental guide 2015 and accept the Club’s Code of Conduct.
I have read and agree to the club policies on the website or in the yearbook.
Photography: I do / do not (delete as appropriate) consent to images of my child/children participating in Halifax Canoe Club activities being used for Club publicity, including on the Club’s website.
Signature: Date:
5. Boat Storage Limited Boat storage is available in the clubhouse (at the owners risk).
No of Boat Storage spaces required x £35 per year = £
If you already have a boat(s) in storage, please give location______
and a description of the boat(s) being stored (i.e. make / model / colour)
Please Complete:
Main membership form, including signature, read policies & ‘do or do not‘ consent to photography
Health and Safety forms (1 per person)
Correct money and payment form (Payment information is now on a separate sheet)
Bring forms and payment to membership night 28 March 2017or send before the end of March 2017 to:Sarah Ford (Treasurer), C/O 27 Kistvaen Gardens, Meltham, HolmfirthWest Yorkshire, HD9 5NQ
Contact for any queries: 01484 854099 or
Office Use only: payment information received Y / N Date:MEMBERSHIP PAYMENT
Apologies for the additional paperwork, it won’t all fit on one double sided form now.
Full Name on membership application:
Post Code: Telephone No:
Email:
6. Fees Due (from main membership form)
1a / Membership type (Full, junior, family or concession) / £1b / British Canoeing affiliation (£2.20 per adult) Required for all adults who are not a British Canoeing member / £
5 / Boat Storage (£35 per boat) / £
Main door key (£20 if new) Key Number……….. / £
Other / £
Donation (if you pay tax you can gift aid any donation we can claim 25p on every £1 you donate) / £
TOTAL / £
I have paid my membership in full by:
Payment method / Date / Reference (if applicable)Cash/ Cheque (Halifax Canoe Club Ltd)
Bank Transfer (please contact treasurer)
Standing Order (please contact treasurer)
SignedDate
Gift Aid – the Club is a Community Amateur Sports Club and as such can claim gift aid on any donation. If you pay tax please consider signing and returning the attached gift aid form which will enable us to claim 25p for every £1 donation in the past 4 years or in the future. Many thanks
Bank Transfers – you may now make membership payments using a bank transfer system. Please contact Sarah Ford, Club Treasurer – contact details below.
Standing Orders and Split payments
It is possible to pay via Standing Order and/or split your membership payments, please contact me for details.
Many Thanks
Sarah Ford (Treasurer), C/O 27 Kistvaen Gardens, Meltham, Holmfirth West Yorkshire, HD9 5NQ
Contact for any queries: 01484 854099 or
Gift Aid It
Gift Aid Declaration – for past, present and future donations to
Halifax Canoe Club (Community Amateur Sports Club)
------
Please treat as Gift Aid donation all qualifying gifts of money made
Today in the past 4 yearsin the future
Please tick all the boxes you wish to apply
I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASC’s) that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity/CASC will reclaim 25p of tax on every £1 that I give on or after 6 April 2008.
Donor’s details
Title………………………First Name or initial(s)…………………………………………………………...
Surname……………………………………………………………………………………………………….
Full Home Address ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Post Code………………………
Date………………………….Signature …………………………………………….
Please notify the CASC if you:
1.Want to cancel this declaration
2.Change your name or home address
3.No longer pay sufficient tax on your income and/or capital gains
If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donation on your Self Assessment tax return or ask HM Revenue and Customs to adjust your tax code.