New Member Form | Clevedon Pilot Gig Club

Your Name

Email Address

Contact Number

Membership Type

Supporter (£25 per couple)

Junior Rower (8-16 yrs) (no charge)

Full Time Student (17+) (no charge)

Adult Rower (£150)

Family (£225)

Summer rowing only (May-Sept includes regattas) (£100)

Optional Donation (eligible for Gift Aid, see below) £

Total Paid (Fees plus Donation) £

Enter the total paid to the club bank account (sort code 40-17-50 account number 31440748).

Members participating in rowing sessions and other events organised by Clevedon Pilot Gig Club do so entirely at their own risk and the Club accepts no responsibility for personal injury or loss as a result of any involvement whatsoever. Members are also reminded that they must be medically fit to row and adhere to the Club’s and the CPGA Health & Safety Guidelines.

Other members included in this payment

For couple/family memberships

Dates of Birth (rowers only)

Address

Address 2

City/Town

Postcode

Please treat the following amount as a Gift Aid donation £

You must pay an amount of income tax and/or capital gains tax in this tax year of at least equal to the tax that the Charity will claim from HM Revenue & Customs on your Gift Aid donation

Please ensure that you keep your contact details up to date at My Account.

By clicking the submit button below, I confirm the details above are correct and agree to abide by the Club's code of conduct.

WATER SPORTS READINESS QUESTIONNAIRE

Regular physical activity is fun and healthy and being more active is very safe for most adults. However, some should check with their GP before becoming much more physically active. The Cornish Pilot Gig Association and Clevedon Pilot Gig Club accept no liability for persons who undertake physical activity and, if in doubt, consult your GP.

Has your GP ever said that you have a heart condition and that you should only do physical activity recommended by him or her?

Yes

Do you feel pain in your chest when undertaking physical activity?

Yes

In the past month, have you had a chest pain when you were not undertaking physical activity?

Yes

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes

If yes, please list the bone/joint problem here.

Is your GP prescribing drugs (for example, water pills) for your blood pressure or a heart condition?

Yes

Do you know of any other reason why you should not exercise?

Yes

If yes, please list other reason(s) here.

I CERTIFY THAT I AM ABLE TO SWIM IN EXCESS OF 50m

Yes

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