Healing Dragons Registration Form

Annual Membership Form
Our Mission:
Healing Dragons, a non-profit organization, empowers cancer survivors and supporters to be courageous through the team sport of dragon boat paddling.

Our Vision:
Our vision is to provide a restorative path for cancer survivors and supporters to achieve emotional and physical wellness.

Our Core Values:
We live by the values of teamwork, community, fun, authenticity, friendliness, respect, diversity and inclusion.
Select one:*

New MemberReturning Member
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Are you a cancer survivor or a friend/family of a survivor?*

SurvivorFriend/Family of a SurvivorOther
If survivor, what is your Cancer Anniversary date?

MonthDayYear
Date
If survivor, what type of cancer?
Birthday*

MonthDayYear
Date
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Medical Emergency Information*
Please indicate any special medical emergency items that the Team Captain/Coach should be aware of, such as allergies, inhalers, etc.
Dietary Restrictions
IMPORTANT: As with any strenuous exercise program, please consult your physician prior to participating in dragon boating to ensure that you do not have a medical condition that would prevent you from participating.

COVID-19: Healing Dragons is committed to keeping all members healthy and safe, while enjoying our team sport. We follow the CDC recommendation that everyone who is eligible, to get vaccinated and stay up to date on your COVID-19 vaccines, including people with weakened immune systems. Due to the close proximity of one another on the boat, please help protect yourself and all team members.
ACCEPTED FORM OF PAYMENT:

Check: Pay to Healing Dragons, Inc. Check may be mailed in, or given to our Treasurer, or Captains.

Zelle: Send to HealingdragonsCLT@outlook.com (no service fee)

PayPay: Send to HealingdragonsCLT@outlook.com. Please add 4% to your payment to defray the PayPal service fee.

Cash: May be given to our Treasurer, or Captains, preferably in an envelope. Clearly write your name and amount on the outside of envelope. Please do not mail cash.

Checks may be mailed to:

Healing Dragons of Charlotte

P.O. Box 2521

Cornelius, NC 28031
Please note that Healing Dragons welcome all cancer survivors, family or friends of cancer survivors. If you wish to join but have a financial hardship, you may contact our President for a private and confidential discussion about financial assistance, at ginameli97@gmail.com.
Special Volunteer Interests: (select all that apply)

Social MediaCoachingSteeringEquipment Set-upSocial EventsMarketingCommunity EngagementMembershipLeadershipSafetyBoat Maintenance
How did you hear about Healing Dragons? (select all that apply)

Existing MemberFriend/FamilyNewspaper or MagazineWebsiteWeb SearchFacebookMeetupDoctorOther
What methods of communication are most effective for you? (select all that apply)

EmailText MessagePhone CallMail
Every member must sign an annual release of liability waiver form (paper form only) administered by our Team Captains, upon joining Healing Dragons, or prior to getting on the boat.

By submitting this form, you agree that Healing Dragons may photograph or video record you and use those photographs or videos for marketing purposes. You agree that your contact information may be shared within the team for internal team related use only. You also agree to the terms in the HEALING DRAGONS AMATEUR ATHLETIC RELEASE OF LIABILITY WAIVER.
Product Order
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Annual Team MembershipThe Annual Team Membership Fees are used by Healing Dragons to fund core team expenses such as insurance, regional dragon boat association fee, marketing materials and equipment needs. The team provides paddles, personal flotation devices (PFDs) and the boat.
$100.00



Team Jersey (Sleeveless)Limited sizes are available until inventory is restocked
$50.00 T-ShirtQuantity



Team Jersey (Short Sleeve)Limited sizes are avaiable until inventory is restocked
$50.00 T-ShirtQuantity



Team Jersey (Lady Cap Sleeve)Limited sizes are available until inventory is restocked
$50.00 T-ShirtQuantity



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$0.00
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Annual Membership Form