KCC Pathfinders Annual Membership Form

Membership Application Type: *

Membership Renewal (was member in previous year) (£5) New Member (£5) Beginner's Course (£50) (only complete and pay if place assigned by lead coach David Surman)

Please accept my application for annual membership of Kingfisher Canoe Club - Pathfinders Youth Section, for the year beginning January

Enter Year of membership: *

e.g. 2021

Youth Member's Name: *

Title First Name Last Name

Youth Member's Gender: *

Male Female

Date of Birth *

DD/MM/YYYY

Address *

House Number/Name & Street

Optional

Town County

Postcode Country

Parent/Guardian Email Address: *

Confirmation Email example@example.com (A copy of this form will be sent to this address)

Additional Email Address(es) (optional):

example@example.com. If multiple email addresses, separate with a comma (,)

Landline Number:

e.g. 01235123456

Parent/Guardian Mobile: *

For emergency use. e.g. 07123 456789

Additional Parent/Guardian Mobile(s):

If multiple phone numbers, separate with a comma (,) 0/40

British Canoeing Awards/Qualifications:

e.g. BC 1 star, First Aid.

Is the Youth Member a current paid-up member of British Canoeing? *

Yes No

If they are BC member, what is their Membership Number?

This allows us to tie their KCC membership into their BC membership

GP Name & Surgery: *

Medical Conditions:

Anything relevant we should know about?

I confirm that my son/daughter can swim 50 metres in light clothing.

I confirm to the best of my knowledge that my son/daughter does not suffer from any medical condition other than those listed. I consent to my child receiving emergency medical treatment which, in the opinion of a qualified medical practitioner, may be necessary.

I consent that photographs taken by authorised personnel, of my son/daughter at British Canoeing or Club events, may be used to promote paddlesport and confirm that my son/daughter is not subject to any court order prohibiting publication of their image.

I understand that the Club accepts no responsibility for loss, damage or injury caused by or during attendance of Club events, except where such loss, damage or injury can be shown to result directly from the negligence of the Club.

The information that you provide to the Pathfinder Youth Section of the Kingfisher Canoe Club will be securely stored for membership purposes in order to: -

(1) Communicate club events, news and information.

(2) Allow coaches and organisers to deliver Pathfinders events and trips.

(3) Claim Gift Aid on donations where appropriate.

(4) Deliver necessary medical care.

We promise to keep your details safe and you can request for your data not to be used for any of these purposes at any time by contacting us. Personal data will be deleted 2 years after membership expiry. We may continue to send email communications after this period unless you unsubscribe, which can be performed at any time.

British Canoeing want to communicate with Club Associate Members and contact these members individually on a monthly basis. Please confirm that you would like to be contacted direct by British Canoeing. If yes, tick here:

YES

Parent/Guardian Name *

First Name Last Name

Parent/Guardian Signature (click mouse to sign): *

Clear

Date of Signature *

DD/MM/YYYY

Total to pay

Payment *

GBP Youth Membership

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration