Learn To Row Membership Application Form

Rower's Information
T-shirt size (Adult sizes)
S, M, L, XL, XXL
Rower's Name *

First Name Last Name
Rower's Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Rower's Home # *

Area Code Phone Number
Rower's Cellular #

Area Code Phone Number
Rower's E-mail
Rower's School *
Birth Date *
Age *
Grade *
Gender *
Height *
Weight *
Have you rowed before *
What other sports do you Participate in?
Can Rower Swim? *
Please list any medical conditions or allergies that the coach should know
Parent/Guardian Information
Parent/Guardian (1) Name *

First Name Last Name
Parent/Guardian (1) Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Parent/Guardian (1) Home *

Area Code Phone Number
Parent/Guardian (1) Cellular *

Area Code Phone Number
Parent/Guardian (1) Work

Area Code Phone Number
Parent/Guardian (1) E-mail *
Parent/Guardian (2) Name

First Name Last Name
Parent/Guardian (2) Address

Street Address

Street Address Line 2

City

Postal / Zip Code
Parent/Guardian (2) Home

Area Code Phone Number
Parent/Guardian (2) Cellular

Area Code Phone Number
Parent/Guardian (2) Work

Area Code Phone Number
Parent/Guardian (2) E-mail
Emergency Contacts
Emergency Contact (1) Name *
Name
Emergency Contact (1) Phone # *

Area Code Phone Number
Emergency Contact (1) *
Relationship
Emergency Contact (2) Name *
Name
Emergency Contact (2) Phone # *

Area Code Phone Number
Emergency Contact (2) *
Relationship
Medical
In case of emergency, every attempt will be made to reach the emergency contact listed above. If no one can be reached, I give permission for the Wappingers Crew Club to seek medical attention for the above named rower.
Parent/Guardian *

First Name Last Name
If under 18, Parent or legal Guardian Signature. *

To sign signature pad, use mouse and hold down button or for touch screens use pen or finger. Clear
Policy Holder *

First Name Last Name
Policy # *
Insurance Company *
I give W.C.C. permission to use my child's picture in newspaper articles and on the W.C.C. web page.
Responsible Parent/Guardian Signature. *

To sign signature pad, use mouse and hold down button or for touch screens use pen or finger. Clear
Cost of Learn To Row Program: $150.00

Payment Options:

1. Venmo the payment to @wappingers-crew-club

2. Checks made payable to Wappingers Crew Club

PO Box 221 Hopewell Junction, NY 12533
Please select ALL shifts you can attend for Learn to Row. Athletes will be assigned to 2 shifts based on availability. We will accommodate preferences on a first come first serve basis. Because of equipment restrictions we need all shifts be evenly filled. Sessions begin September 14th and end October 29th. *Note- If not enough athletes can attend the early session on Wednesday, will be consolidate Wednesday into 1 session and adjust the time slightly.

Wednesdays 4pm - 5:15pm Wednesdays 5:15pm - 6:30pm Saturdays 9am - 10:30am Saturdays 10:30am - 12pm
How did you hear about WCC?

New Student Orientation Annoucements Friend/Family Social Media
Should be Empty:

Rower's Information

Parent/Guardian Information

Emergency Contacts

Medical