Adult E-Consent Form

WOMBOURNE KAYAK CLUB TRIP PARTICIPANT CONSENT STATEMENT

Consent for Club Trips, Club nights and Pool sessions.

Participant Declaration

I will watch safety brief given by the leader(s) for the trip, including the reading of the Risk Assessment.
If I am unclear on any parts of the activity or instructions I will ask the leader(s) to clarify any points I am uncertain of.
I understand that White Water kayaking is an outdoor adventure activity and an assumed risk sport, as such it carries an element of risk, and potential for damage to kit, personal injury and death.
I acknowledge that these risks mean it is vital I listen to and follow safety instructions and act responsibly.
I confirm that neither the club nor leaders/coaches will be held liable for any accident, injury, damage or death unless it is proven to result from negligence.
I have declared all medical conditions in the Medical Information section of this form.
I will not paddle, set safety or drive under the influence of Alcohol or Drugs.
I declare that I am able to swim and am confident in and around water.
I acknowledge that I will, under no circumstances, be able to participate in river activities without the correct and functioning PPE, including suitable buoyancy aid and helmet (inc correct leash system for SUP’s). Clothing suitable for the weather/water conditions must be worn. The suitability of PPE is at the discretion of the leaders responsible on the day.
I understand that boats used on the river must be fitted with air bags, have functioning grab handles and be in decent working condition. The suitability of my craft for the activity will be at the discretion of the leaders responsible on the day.
I am aware that the session may be canceled for operational, weather, or environmental related safety issues.
I agree to abide by British Canoeing’s ‘Go Canoeing’ Code of Practice.” see Code of Conduct for Coaching Workforce.
I have read, understood and agree to abide by the Wombourne Kayak Club codes of conduct.
I will register my emergency contacts in my mobile phone so that they can be accessed while it’s locked.
I’m aware that the affiliated club insurance only covers 3rd parties and is not a form of personal insurance.
I am responsible for completing this form accurately. I am responsible for any errors and omissions to personal information and accept liability for any direct or indirect consequences that arise from these errors or omissions.
All data gathered on this consent form will be utilised only for the purposes detailed on this form and will be processed and stored in compliance with the British Canoeing Data Protection Policy and in accordance with all applicable Data Protection laws in effect at the time of publication of this form.

Thank you for your response. ✨

In completing the below I declare and agree with the above statements and are aware of the risks associated with participating in this activity.

I consent to photos and videos to be taken for use in the promotion of the club and/or paddlesports

I understand that WhatsApp is used as the main tool of communication within the club. I consent to being added to the group chats. (its important to note that the phone numbers of all participants are visible to all other club members in WhatsApp chats, email can be used instead if preferred).

Name

Phone

Emergency Contact Name

Emergency Contact Phone Number

Swimming Ability and Anything Else Organisers Should Be Aware Of:

Medical Consent

Do you have a disability you wish to disclose? If so please enter details and required accommodations below. As a club we are committed to being as accessible as possible.

It is important that river leaders know whether you suffer from any illness, injuries or medical conditions. Please use the space below to state in confidence any health or other matters of which we should be aware. Please also indicate if the participant is receiving any medication, with details and dosage, and/ or specific dietary requirements. Medication that may be needed on the river in an emergency (e.g. inhaler, epipen) should be handed over to a river leader for the duration of the trip.

Do you suffer from (please tick for yes):

If yes to any of these please add further information here concerning medication and emergancy measures.

Doctors Name

Doctors Phone Number

I consent to receiving appropriate first aid or in a medical emergency consent to medical treatment which, in the opinion of a qualified medical practitioner, may be necessary.

Please choose one:(required)

Yes

Further details if needed: