Registration 2014

1053 Catherine Bagley Rd.

Severn Bridge, Ontario P0E 1N0

(705) 689-0055

Personal Information (please print clearly)

______Male Female

Last name First Name

Mailing Address ______Birthdate (mm/dd/yy) ______

______Home Phone Number: ______

______Work Phone Number: ______

Email address: ______Cell Phone Number:______

Parent’s email ______

(if under 18 years)

Club Fees - $299.00
Capital Fund: $50.00
Total $349.00
Includes coaching, equipment rental, equipment purchases, equipment insurance, maintenance & repairs, gas, administration, and club registration fees (RCA, RO, & CORA Assoc. Fees) and other associated costs. / Association Fees:
Rowontario : (circle a or b)
a) Sport Rower - $ 10.00
b) Competitive - $ 44.00
Rowing Canada Aviron (RCA):(fee increase) circle a or b)
a) Sport Rower - $ 10.00
b) Competitive - $ 47.00
Associate Member (non-rowing member):
Non-rower/club supporter - $50.00 / Regatta Fees:
Pay as you go (all members are responsible for remitting regatta entry fees to the club)
Trailering Fees:
Will vary depending on # of participants, truck/trailer/gas costs.
Uniform: Racing singlet -$50.00
Dri-Fit Hat - $30.00
T-shirt - $20.00
Example Competitive Rower: Club Fee - $349.00 + $44.00 (Rowontario Fee) + $47.00 (RCA Fee) = $440.00 + Volunteer $100 Deposit
Sport Rower: Club Fee - $349.00 + $ 10.00 (Rowontario Fee) + $ 10.00 (RCA Fee) = $369.00 + Volunteer $100 Deposit
Volunteer Deposit: post dated cheque dated November 30th of $100 which will be returned (post season) to each member if a minimum of 10 hours of volunteer work is completed.

The name, address and date of birth information are forwarded to Rowing Canada Aviron (RCA) and Rowontario for the purpose of membership registration and insurance as well as for regatta entries. RCA is requesting permission to use your personal information for the following: a) solicitations from RCA’s sponsors, b) solicitations from within RCA for other commercial activities, c) posting rosters, statistics, images and results on the Rowontario and/or the RCA website.

I authorize (___). Or refuse (___) permission to Rowing Canada Aviron (RCA) and Rowontario for the other additional purposes listed.

X ______

Signature Date

Medical Information

In case of an emergency, contact ______Phone ______

Family Physician ______Phone ______

On your last medical examination, did your doctor find you fit to participate in a demanding sport?

Yes No If no, please explain ______

Special Notes (i.e. allergies, medical condition, etc.) ______

RELEASE, WAIVER AND ASSUMPTION OF RISK
To: the SEVERN RIVER ROWING CLUB, its directors, officers, coaches and members.
The undersigned understands, acknowledges and agrees that participation in rowing/sculling involves risks and dangers that include, but are not limited to, cold weather and water. In consideration of you permitting me to enter your premises or engage in rowing/sculling, accompanied or unaccompanied (meaning with or without a launch), using club or private equipment:
1. I agree and acknowledge that:
a)  before going on the water, I have read the safety handbook available on-line at www.rowingcanada.org/safety/safety_guideline/, and assume responsibility for examining all updates thereof;
b)  I am a competent swimmer and am able to:
swim 25 metres without stopping (no time limit). Then, without a break,
tread water for five continuous minutes; then, without a break,
put on a life jacket while treading water.
c)  I am familiar with and understand the dangers associated with cold weather and water, specifically hypothermia and know how to deal with it, should an accident occur;
d)  I shall stay informed of special activities and programs ongoing at the Club, and be bound by all rules established by the Severn River Rowing Club;
e)  I shall notify immediately the Club Manager, or in his/her absence, a Club officer, of any incident within my knowledge, affecting the Club or its members, or regarding any obstruction or dangerous situation in or on the water and surrounding banks.
2. On behalf of myself and all persons entitled under the Family Law Act, I hereby release and forever discharge you, and each of you, from all liability, loss, damages and costs arising from any injury, death, loss or damage to my person or property whenever or however caused arising out of, or in connection with, my use of your premises or property, or my rowing/sculling activity, on water or land, notwithstanding that such injury, death, loss or damage may have been contributed to or occasioned by negligence of you.
3. I give permission to the Severn River Rowing Club to use my picture in pamphlets and/or the media to promote the activities of the Club.
______
Member’s signature Date

PARENTAL CONSENT (for members under 18)

I ______(parent-guardian) request that my son/daughter______be allowed to participate in rowing/sculling as provided by the Severn River Rowing Club. I acknowledge that the Release, Waiver and Assumption of Risk document signed by my son/daughter has been read by me and I agree with the contents.

In consideration of my son/daughter being allowed to participate, I for myself, Heirs, Executors, Administrators and Assigns, hereby release and forever discharge and hold harmless the Severn River Rowing Club, its Directors, Officers and Agents (including coaches) from any liability for injury, death, loss or damage to property, sustained by my son/daughter, named above, howsoever caused, arising out of, or in connection with the said son’s/daughter’s participation in rowing/sculling activity, notwithstanding any negligence contributed or occasioned by the Severn River Rowing Club, its Directors, Officials and Agents (including coaches).

______

Parent/Guardian signature Date

Volunteer Form

The Severn River Rowing Club is a not for profit organization that relies heavily on volunteers in order to be successful. The club’s goal is to have each member contribute a minimum 10 hours per year.

Possible opportunities to complete volunteer hours for the Severn River Rowing Club:

ü  Docks In (April)

ü  Docks Out (October)

ü  Pre-season rigging & unloading trailer

ü  Post-season rigging & loading trailer

ü  Safety Boat Driver

ü  Committee Member – Severn River Sprints

ü  Committee Member – Muskoka Fall Classic

ü  Grass cutting at Severn River Inn

ü  Coaching – NCCP Instructor course (course available April 2014) or experience

ü  Boat cleaning & maintenance

ü  Boat trailering

ü  Clothing Sales & Ordering

ü  Regatta Registration and Fee collection *

ü  Fundraising Coordinator *

ü  Newsletter & Media *

ü  Website Updates

ü  Assist with Learn to Row

ü  Volunteer Coordinator *

* This position fulfills your 10 hour volunteer commitment.

A post dated (November 30, 2014) volunteer cheque is due before going on the water with any Severn River Rowing Club shell or equipment.

Damage Policy:

All club members are responsible for the care and control of club equipment. If accidental damage occurs to club equipment, club members are responsible to pay for 50% of the cost to a maximum of $250.