ADULTS LEARN TO ROW COURSE

APPLICATION FORM 2017

Surname / Forename
Address
Post code
Email address
Date of birth / Home tel. no.
Shoe size (UK) * / Mobile no.
Height (metres) * / Weight (kilos) *
Name and Address of emergency contact

* We need this information to find the most suitable equipment for you to use.

Have you any health conditions, impairments or disabilities of which the course organiser and coaches should be aware? If so, please state:

Please give details if you are taking any form of medication:

How would you specify your current activity level?

Health note: Regular exercise may include some risk, especially for those who have been sedentary. Before beginning a regular exercise programme, you should consult your doctor if you are: over 40 and have not done any regular exercise for this past five years; smoke; have high blood pressure/cholesterol; have any signs/symptoms of any disease; experience chest pains/dizziness/loss of consciousness; are recovering from a serious illness or surgery ; have a pacemaker or another implanted electronic device; have any other concerns about your ability to undertake regular exercise.

Swimming competence

I am able to swim at least 100 metres in light clothing.

How did you hear about the course?

THE SMALL PRINT:

Your signature below confirms that you have read and accepted in full the conditions of membership outlined here:

• I apply to become a temporary member of Henley Rowing Club for the duration of the Adult Learn to Row Course

• I understand that there is no refund once I have registered for the course

• I agree to my details being held on the Club’s membership system and by British Rowing

• I certify that my health is my own responsibility but that I will advise the office if there are any issues which may affect my participation in the course.

Applicants Signature ………………...... …………. Date: ………………….

Please specify which course you would like to join:

Adults 1Adults 2

Term 1 –Fridays 6.30pm – 7.30pm Term 1 – Fridays 7.30pm – 8.30pm

Sundays 5pm to 6pm Sundays 6pm to 7pm

Terms 2 & 3 – Fridays 5.30pm to 7pm Terms 2 & 3 – Fridays 7pm – 8.30pm

Sundays 4pm – 5.30pm Sundays 5.30pm – 7pm

Term 1 Commences – Friday 3rd March Ends – Sunday 9th April

Term 2 Commences – Friday 28th April Ends – Sunday 18th June Term 3 Commences – Friday 14th July Ends – Sunday 27th August

Please post this application form and a cheque payable to Henley Rowing Club to:

Beverley MulrooneyContact Details:

Henley Rowing Club01491573943

Wargrave Road

Henley on Thames

RG9 3UD

A reduced one off fee of £990 for three terms or

A first term fee of £120 (Further payments will be charged at£480 for Term 2 and £480 for term 3.)

Please write your full name written on the reverse of the cheque. This fee includes HRC membership for the duration of the course and your first years’ annual subscription to British Rowing