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Name

Date of Birth (DD/MM/YYYY)

Address

Contact Number

Emergency Contact Name

Emergency Contact Number

Membership Level

If you suffer from any medical condition(s) or are aware of an illness
that may affect your ability to take part in any rowing activity
(on the water or in the gym) please provide details below;
If you are healthy, please enter N/A

I can swim 50 metres in winter rowing kit

First Aid Qualifications: As an organisation the club is required to have a number of qualified First Aiders.
Do you have any valid First Aid qualification which is current and you would be willing to allow the club to keep a record of.
Please enter the qualification and expiry date

Declaration: I understand the personal information provided will be held by the club in accordance with the Data Protection Act and will be used to provide membership services to me.
Consent: If you have read the above declaration statement and consent to Erith Rowing Club collecting, processing and storing your data please sign this form (electronically) by entering your full name and then typing I AGREE in the signature box below.

Full Name

Signature

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