MCSRD Form for Individuals

PLEASE NOTE! we at WANT TO CANOE? can not give advice on whether you should participate in our activities, if you have any doubts or concerns please seek the advice of your doctor or other medical practitioner. We do not advise that you participate at WANT TO CANOE? if you are pregnant, have had recent surgery or illness, have a heart condition, high blood pressure, aneurysms or any similar conditions.

COVID-19 – The COVID‐19 virus is a serious and highly contagious disease. The World Health Organization has classified it as a pandemic. Our goal is to provide a safe environment for our clients and staff, and to advance the safety of our local community whilst working strictly within and adhering to all Government and Canoe Wales guidance. The pandemic and subsequently the guidance are changing and the situation is fast-paced. We will be constantly reviewing and updating our procedures and operation in accordance with any changes.

All fields marked * are required


MaleFemale
Under 1616 - 1718 or over

PLEASE NOTE!
1) If you are under 16 you can not consent to your own participation at WANT TO CANOE? and are therefore unable to complete this form - please seek advice at the main office OR CALL 01497 820604.
2) If you are aged 16 - 17 you must provide your parent/guardian details below and they will be contacted prior to your activity to confirm that consent is given for you to participate.

YesNo
YesNo


Emergency contact details / Next of kin:

If you are aged 16 - 17 you must complete all questions on this page! Your parent/guardian will be contacted prior to your activity to confirm that consent is given for you to participate.

YesNo

YesNo

I 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 aged 16 - 17 and confirm that all the information supplied herein is correct. In the event of an incident or accident, I agree to 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.I am over the age of 18 and confirm that all the information supplied herein is correct. In the event of an incident or accident, I agree to 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

YesTick to accept
Yes Tick to subscribe


I have read and agree to the Privacy Policy*

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