READINESS to SUP Assessment

Nb : If you are completing this form on a Smart Phone or Tablet, turning it to landscape mode may help

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number*

Birth Date:*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Relationship to you*

Do you have a disability?*

If Yes - please give details below

Details (if required)

Do you have any medical conditions of which we should be aware?

If Yes - please give details below

Details (if required)

Do you have any allergies?*

If Yes - please give details below

Details (if required)

Please give any other details that may be relevant to your participation in this activity:

This part of the form is intended to make you aware of the risks associated with Stand Up Paddle Boarding (SUP) and to help you make and informed decision as to whether to participate. Signing this form does not (and is not intended to) limit our obligations to you and does not in any way compromise your legal rights. Stand Up Paddling is an “Assumed Risk” and “Water contact sports” that may carry attendant risks. Participants should be aware of and accept these risks and be responsible for their own action and involvement.

Section 1 - I understand that the activities I may participate in will expose me to many hazards and involve the risk of property damage and loss and even personal injury, illness or death. Whilst Sup-Wales will take all reasonable steps to ensure my safety, I understand that they cannot be held liable for my own actions, for which I must take responsibility, or for those of a third party.*

YesNo

Section 2 - I do not have any medical conditions or illnesses other than those disclosed in this form. Despite these conditions I am sufficiently fit, able and competent to paddle and participate in all the activities.*

YesNo

Section 3 -I am a confident swimmer*

YesNo

Section 4 – Entry and Exit is only available through the designate areas identified by the instructor’s reception and equipment through the Instructors*

YesNo

Section 5 - I understand that whilst Sup-Wales will provide me with help and advice whenever they can, I will only receive instruction in the use of equipment or techniques when I have booked and paid for such instruction. I will not participate in any activity unsupervised if I am not confident and capable in the use of any of the equipment or area I am paddling.*

YesNo

Section 6 –I will ensure that I have been informed about the Water Quality by the instructor and understand the Water Quality Information.*

YesNo

I consent to all sections of the Safety and Risk Declaration above

One last thing.

In order for us to get you on the water quicker we try and get your Buoyancy Aid ready for you.

Therefore please select the size of clothes you normally wear below.

That will give us a good indication of what Buoyancy Aid you need.

Buoyancy Aid Size*

Signed - eSignature*

Signed - Date*

MonthDayYear

We may occasionally film or take photographs of participants for publicity purposes, including reproduction on our website If you do not agree to us using photographs or footage that include yourself then please tick the box.

We will always store your personal data confidentially and securely. We require your data in the event that we need pass on any information regarding your booking or membership. It will not be sold to a third party or used for promotional activities unless we have your consent.*

I consent to having this website store the submitted information in the event that I or the emergency contact may need to be contacted.

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Readiness to SUP Assessment

Participant Information

Emergency Contact Details

Medical Information

Safety and Risk Declaration

Signatures