MCSRD Form for Families

Start Date of Canoe Trip*

Name*

Email*

Date of Birth* /  / 

Postcode*

Gender*MaleFemale

MOBILE phone number*

Car Registration Number (if parking at Want to Canoe?)

Name of person who made the booking

Please use the space below to detail Full Name(s) and Date of Birth of all other group/family members (adults and children) participating at WANT TO CANOE? for whom you are completing this form.*

For the safety and health of the want to canoe? staff and instructor team during the Covid-19 pandemic it is not acceptable for anyone outside your booked and confirmed group to join you on the river in their own, hired or borrowed canoe, kayak, SUP or similar.
I/we confirm that all group members have been disclosed to want to canoe? on this and any other relevant MCSRD Form and that we will not be joined by anyone else during our activity.*YESNO

Do you have any medical conditions and/or allergies of which we should be aware? (please don't hesitate to ask if you'd rather speak to a member of staff privately about this)

Do you, any member of your household/bubble and/or any member of your canoeing group have any Corona Virus symptoms?*YesNo

Do you agree to contact want to canoe? immediately should you, any member of your household/bubble and/or any member of your canoeing group develop Corona Virus symptoms prior to your canoeing trip and also up to four weeks after your canoeing trip?*YesNo

Is anyone in the group a non-swimmer?

Please detail any other information that may be relevant to your groups participation in activities at Want to Canoe?

Name

Telephone Number

Relationship to you

We occasionally film/take photographs for publicity purposes, do you agree to us using photos or footage that includes you?*YesNo

We understand that the activities we're participating in will expose us to hazards and involve the risk of property damage, property loss, personal injury, illness and death. Whilst want to canoe? takes all reasonable steps to ensure our safety I understand they can not be held liable for our own actions, for which I must take responsibility, or for those of a third party.*YesNo

We have disclosed all relevant medical conditions on this form. Despite conditions disclosed we are all sufficiently fit, able and competent to participate in the activities specified on booking.We have been able to read and agree to the want to canoe? RULES AND REGULATIONS, COUNTRYSIDE AND RIVER CODE OF CONDUCT and COVID-19 OPERATING PROCEDURES*.

I am over the age of 18 and confirm that all the information supplied herein is correct. I am the legal guardian of the above detailed children and give consent for them to take part in activies provided by want to canoe?. In the event of an incident or accident involving us, I agree to us all receiving first aid from a suitably qualified person and/or any medical or dental treatment which may be considered necessary by a registered medical practitioner.*YESNO

British Canoeing (the national governing body for canoeing in the UK) and [Want to Canoe?] would like to use your name, date of birth, postcode, gender and email address for internal reporting to monitor participation. Personal data will be used only in accordance with the Data Protection Act 1998 and current GDPR Legislation. Your contact details will not be passed to third parties. Tick here if you agree to your information being used in this way. Tick to accept

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