2010 Paddler Registration Form

First Name *

Last Name *

Street Address *

Address Line 2

City *

State/Province/Region *

Zip/Postal Code *

Phone Number *

Country *

Email Address *

What type of Paddler are you? *

Which paddle are you taking part in
*

Name of group if more than one person 🛈

Name of charity you are paddling for 🛈

What section are you entering *

Groms relay NSLSC

Fancy dress fun paddle

Pro relay paddle RNLI lifeguards only

relay paddle 1km

What craft are you paddling *

Surf Board various

canoe - Kyak

boat or Gig must be powered by paddles

other other

	Do you accept the terms and conditions of the joe way Paddle for life
yes	Do you accept the terms and conditions of the joe way Paddle for life
no	Do you accept the terms and conditions of the joe way Paddle for life

I understand that the sea can be an inherently dangerous place. I confi rm that I am a fi t and healthy person and that I am easily able to swim a distance of 100 metres in the sea.

I accept that I am fully responsible for my own health, fitness, safety and welfare both in and out of the water and that my participation in Paddle for for life 2009 is undertaken completely at my own risk.

I accept that the event organisers, it’s staff and associates shall not be held liable for any loss or damage, howsoever arising, suffered by any participant of Paddle for lifel 2009.

I also accept that the event organisers may, at their discretion, refuse to allow me to participate in this event, if I appear to be incapable or intoxicated immediately prior to the start of the Paddle.

I also confirm I am a member of an organisation that covers me for water activities for example BSA, Surf club, rowing club , canoe club or other such organisation. We recommend that if you are not a member then joining British surfing association will cover you.

I confirm I am a member of an organisation or I hold a Qualification connected to water sports or life saving that covers me for water activities for example BSA, Surf club, rowing club , canoe club, RLSS, NPLQ, NARRS or other such organisation/Qualification. We recommend that if you are not a member of a club or hold a Qualification then joining the British surfing association will cover you.

What is name of your insurance provider or Qualification

Do you have a medical issues that would affect you in the water 🛈

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