KILCULLEN CANOE CLUB
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Associate Membership Application Form
Personal Details
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Indicates required field
Full Name
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Email
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Postal Address
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Phone Number
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Gender
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Date of birth
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Emergency Contact
Name
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Phone Number
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Have you any physical or other condition(s) which the club and it’s instructors should be made aware of? Examples include injuries (old or new), dyspraxia, pregnancy, diabetes, asthma, etc. If yes, please give details.
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Please detail any canoe or kayak proficiency awards received.
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Canoeing Ireland membership ID number.
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Rules
I agree to comply with all the rules and regulations of our club, and of our National Governing Body, Canoeing Ireland.
Rules Agreement
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I agree
Application
I hereby apply to participate in programmes or activities organised by Kilcullen Canoe Club (KCC). I have provided my
personal details, which I understand will form the basis of this agreement between Kilcullen Canoe Club (KCC) and
me.
By ticking the box below, I acknowledge and agree to the following:
Acknowledgment of Risk
All sporting activities have an element of danger, and canoeing/kayaking/fitness classes are no exception. While
every care will be taken, I/my child may suffer serious personal injury, as well as loss of property, because of
exposure to the risks and hazards associated with canoeing/kayaking/fitness classes. I voluntarily assume all such
risks and hazards.
I accept that canoeing is an adventurous sport, which by its very nature is a sport that involves a degree of risk of
personal injury or death. acknowledge that Kilcullen Canoe Club cannot ensure my complete safety at all times, I
accept these risks and agree to be responsible for my own actions and involvement. I accept that Kilcullen Canoe
Club cannot be held liable for any injuries caused to me or caused to others or their property by me, due to my
participation or involvement in this sport.
Compliance with Club Policies
I agree to abide by all the policies and rules laid down by Kilcullen Canoe Club, as amended from time to time.
I/my child will wear a buoyancy aid, helmet, footwear, and suitable clothing during all club activities.
I, or/and my child, agree to follow the instructions of club officers or instructors in accordance with the club's policies
and procedures.
The KCC Constitution, policies, and rules are published on the club website at www.kilcullencanoeclub.com.
Liability Waiver
I understand that by accepting the terms of Kilcullen Canoe Club and signing this agreement, I/my child will be
precluded from suing or otherwise claiming against Kilcullen Canoe Club, its property, or owners, for any loss or
damage, howsoever sustained.
Consent for Communications in line with GDPR
I consent to Kilcullen Canoe Club using my contact information (email address and phone number) to send
clubrelated updates, event notifications, safety messages, and other relevant communications through email and
WhatsApp.
I understand that my contact details will only be used for club purposes, in accordance with GDPR regulations. I note
I can withdraw my consent at any time by notifying Kilcullen Canoe Club in writing or by email. Kilcullen Canoe Club
will not share my contact details with third parties without my explicit consent, unless required by law.
Application Agreement
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I agree.
Club SAfety Statement
As a member or participant in Kilcullen Canoe Club (KCC) activities, I
acknowledge and agree to the following:
General Safety Guidelines
Always let someone know where you are going, what you are doing, and what time you will be back.
Do not canoe/kayak if you cannot swim or float confidently.
Always wear adequate buoyancy and ensure there is sufficient buoyancy for your canoe/kayak.
Always sign in and out gear from the Club.
Report any damages or breakages to the Club committee.
Be aware of your skill set when paddling and do not exceed your capabilities.
Understanding of Risk
Canoeing, kayaking, and other water-based activities involve inherent risks, including potential injury or loss of
property. While KCC takes every reasonable precaution to ensure safety, I accept responsibility for my own safety and
well-being during club activities.
Compliance with Safety Policies
I agree to wear a buoyancy aid, helmet, and appropriate clothing during all club activities.
I will adhere to the instructions of club officers, instructors, and safety personnel at all times.
I agree to familiarize myself with the club’s safety policies and procedures, which are available on the club website at
www.kilcullencanoeclub.com.
Personal Responsibility
I confirm that I am in good physical health and capable of participating in canoeing/kayaking activities.
I will inform the club of any medical conditions or concerns that may impact my participation.
I will inspect and ensure that all equipment I use is in good condition before each activity.
Waiver of Liability
I acknowledge that participation in KCC activities is voluntary and undertaken at my own risk.
I agree not to hold Kilcullen Canoe Club, its officers, instructors, or members liable for any injury, loss, or damage
sustained during club activities.
Emergency Procedures:
I understand the importance of reporting any incidents, hazards, or concerns immediately to a club officer or the
Safety Officer.
I agree to participate in any safety drills or training sessions as required by the club.
I have read, understood, and accept the terms outlined in this Safety Statement. By ticking below, I confirm my
agreement to abide by Kilcullen Canoe Club’s safety policies and procedures.
Club Safety Agreement
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I agree
Submit
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