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MEMBERSHIP APPLICATION FORM

APPLICANT CONTACT INFORMATION

Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!

NEXT OF KIN CONTACT INFORMATION

(in case of emergency)
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!

WATER READINESS QUESTIONARE

Health



Currach rowing, and its associated activities with Row the Erne (RtE), is a healthy and fun form of physical exercise.

We want to be as inclusive as possible, but for health and safety and wellbeing reasons, before participating in any activity relating to rowing with RtE, you must make a declaration about your health.

Please note a health issue may not necessarily exclude you from participation.



Do you have or have you ever had?

Heart, blood pressure or other circulation issues where a GP has indicated that you should only exercise under supervision?
Field is required!
Chest pain in ordinary life or when exercising?
Field is required!
Bone or joint issues (e.g. back, hip or knee) that may be aggravated by physical activity or contact?
Field is required!
Respiratory issues, dizziness, blackouts or unexplained losses of consciousness?
Field is required!
Routinely taking any medication?
Field is required!
Any other medical issue that may be relevant to exercise and a degree of heavy lifting?
Field is required!

Many conditions can be accommodated or managed with medication but if you answered YES to one or more of the above questions please visit or speak with your GP and sign the declaration below before participating in our water activities.

If you have any other condition that is not listed please inform the Committee/Skipper.

The Club may ask you to get a letter from your doctor declaring that you are fit to row with Row the Erne.

Swimming



We row on inland waterways, tidal estuaries and at sea.
Members must be aware that even on our regular rows there is the potential that you might end up in the water. It is an inherent risk.

While it is not a requirement that you can swim, we would encourage you to learn to swim for safety reasons.

Can you swim?
Field is required!
Are you a confident swimmer?
Field is required!
Do you lack water confidence?
Field is required!
Agreement

I certify that if I have answered YES to one or more of the above health questions, I have consulted my GP who has confirmed that I am able to participate in this water sport.

I realise that my participation in these activities involves a risk of injury, hereby confirm that I am voluntarily engaging and undertake this at my own risk.

I have read, understood and answered honestly the questions above. Any questions I had were answered to my full satisfaction by the club Safety Officer.

Field is required!
Field is required!
Field is required!

If I cannot be immediately contacted, I give consent for Row the Erne to act ‘in loco parentis’ for obtaining treatment in the event of a medical incident.

(As parent or guardian to any member under 18 years)

Field is required!
Field is required!

GDPR COMPLIANCE

I understand that rowing/sailing and participating in water and land activities with Row the Erne involves participating in outdoor adventure activities, which by their nature involve a risk of personal injury or death.

Field is required!

These activities are undertaken at my own risk and I disclaim any responsibility from Row the Erne for the fact that I have decided to participate in these activities based on my honest and full disclosure to RTE of my ability.
(Dishonesty/ omission in any part of this process is not only dangerous for you and other members but also the Club itself.)

Field is required!

I agree to replace or repair any equipment that I/my son/my daughter damage(s).

Field is required!

I have read and agree with the Club’s rules and the safety statement.

Field is required!

I agree to pay the required fees.

Field is required!

I agree that I have read, completed and understood the Rowing Readiness Questionnaire (RRQ).

Field is required!
Field is required!
Field is required!
Field is required!

MEDICAL FORM


This information is essential to ensure your safety while participating in Row the Erne activities.

Please answer all questions honestly on the form. Answer N/A where applicable.

Have you had any serious illness or injury in the last five years?
Field is required!
Field is required!
Do you have any of the following medical conditions?
Field is required!
Field is required!
Are you taking medications?
Field is required!
Field is required!

If you bring your medications with you, it is your responsibility to tell the skipper, what you have, where it is and how it must be administered in the case of emergency. E.g. inhaler. EpiPen, glucose gel.

Do you currently have any mobility issues, or do you have any difficulty bending/ lifting?
Field is required!
Field is required!
Are you pregnant?
Field is required!
Can you swim 50m fully clothed?
Field is required!
Please indicate if you have any of the following:
Poor eyesight
Field is required!
Loss of hearing/Deaf
Field is required!
Field is required!

Informed Consent:



I confirm that I have completed the above questionnaire to the best of my ability, and that I have provided accurate information regarding my current health status. I take it upon myself to discuss any changes in my health with the skipper.

I understand that Row the Erne activities have certain risks. I also understand that the degrees of risk depend on my health and physical fitness. I am voluntarily participating in the activities of Row the Erne. I will immediately discontinue any activity if feeling unwell and I will notify a member of Row the Erne. In this respect I hereby indemnify the club that is Row the Erne, and its committee.

Field is required!
Field is required!
Field is required!