Youth Program 2025

$100.00

BY PURCHASING A DRAGON BOAT YOUTH PROGRAM MEMBERSHIP, YOU AGREE TO THE FOLLOWING TERMS AND CONDITIONS:

WAIVER*: I have read and understand the waiver statement (Notice of Waiver) as displayed on the club website. I am aware that by electronically submitting this membership application I am waiving certain rights which I or my next of kin, heirs, executors, administrators and assigns may have against Fort Langley Canoe Club and others.
Conditions of Membership: I understand that by electronically submitting this membership application I agree to comply with all conditions of membership as displayed: Conditions of Membership
Code of Conduct: I understand that by signing this application form I agree to comply with all terms of the Members’ Code of Conduct as displayed: Members Code of Conduct and Privacy Policy

Youth’s Name

Youth’s Mobile Phone Number

Youth’s Email Address

Youth’s Birthdate, dd/mm/yyyy

Youth’s Personal Health Number

Youth’s Physician’s Name

Youth’s Physician’s Phone Number

List all youth’s medical concerns (including allergies & reactions) Please provide details. If none, please type ‘none’.

Youth’s emergency medication carried (Please provide details & details of use). If none, please type ‘none’.

Youth’s Swimming Level

Non-Swimmer

Basic

Advanced

Youth’s Other Water-sports Skills. If none, please type ‘none’.

Emergency Contact #1 Name (Parent/Guardian)

Emergency Contact #1 Relationship

Emergency Contact #1 Email Address

Emergency Contact #1 Mobile Phone Number

Emergency Contact #2 Name

Emergency Contact #2 Relationship

Emergency Contact #2 Email Address

Emergency Contact #2 Mobile Phone

Parent/Guardian Consent Information

I give my consent that, if an emergency medical situation arises, the Club and/or person(s) in charge may act on my behalf for administration of first aid and/or medical treatment that in the opinion of a qualified medical practitioner may be necessary.

I also understand that in such circumstances all reasonable steps will be taken.

Yes

I will advise the Club of any changes in my child/youth’s medical condition.

Yes

I, parent/guardian give my child/youth permission to participate in the FLCC Youth Program, with conditions as noted.

Yes

Category: Memberships

Youth Program 2025

BY PURCHASING A DRAGON BOAT YOUTH PROGRAM MEMBERSHIP, YOU AGREE TO THE FOLLOWING TERMS AND CONDITIONS:

Parent/Guardian Consent Information

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