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Adult Consent Form

Download a printable copy here. 

Contact Details

Name:
Date of Birth:
Now
Home Number:
Address: (Non Member's Please provide your Postal Address)
Postcode:
Mobile Number:
Email Address:
  Membership Status:
I agree that I will not hold the Club, its Officers, Members or assistants liable for any injury or damage or loss suffered by me, while engaged in Club Training activities either on Club premises or elsewhere, or activities for which the Club is or may be responsible and I will indemnify the Club, its Officers, Members and assistants against all actions, claims or demands which might arise.

I understand that sailing & powerboating, in common with all water sports, has its attendant risks. I further understand that the Club is only able to provide rescue facilities during the hours of Club racing/training and that, outside these hours, the Club cannot be expected to exercise supervision or control. I understand that, even during Club activities, the Club cannot accept responsibility for children or any other persons not engaged in racing or training.

I understand that RYA Senior Instructors or RYA Coaches do not accept responsibility for any loss, damage or injury suffered by persons and/or their property arising out of or during the course of their activities while training and/or coaching and/or instructing, unless such injury, loss or damage was caused by, or resulted from negligence or deliberate act.

Emergency Contacts

Name of Next of Kin:
Relationship: 
 
Next of Kin Address:
Next of Kin Mobile Number:
 
Name of Doctor:
Surgery Telephone:
 

Medical Information

It is your responsibility to inform the Royal Lymington Yacht Club of any known or potential medical conditions that may affect the above during the activities associated with the training programme or event you are taking part in.  Please therefore provide as many details as possible.  This information will be shared with key organisers and coaches at training and events.

I consider myself to be physically fit and able to take part in activities associated with the training or event I am participating in.
I can swim at least 25m
or 50m
in light clothing.
Has the above ever suffered from any of the following conditions?
 
If you have answered Yes to any of the above, please provide details and specifically how this may impact their sailing and time on the water:
Is the named person currently taking any medication? 
 
If Yes, please specify below:
Do they have a dietary requirement or food allergies?   

If Yes, please specify below:

Online Submission

By checking the “Accept the Terms and Conditions” box and clicking the “Submit” button on this page, I am declaring that I have disclosed any medical problems that might possibly affect the above named person during the course of the Royal Lymington Yacht Club’s activities and that this information may be stored on the Club’s database.

I declare that I have disclosed any medical problems that might possibly affect me during the course of the Royal Lymington Yacht Club’s activities.

I accept that my email address and telephone number will be stored in the Club’s database and will be available to the Chief Instructor.

I give permission to the organisers to administer any relevant treatment or medication to the above named participant when or if necessary.

I am over 18 years of age, if you are not over 18 this form must be signed by a Parent or Guardian. (The minimum age for taking part in a training course is 8 years old.)

I also agree to the below;

RISK STATEMENT
It must be recognised that sailing is by its nature an unpredictable sport and therefore inherently involves an element of risk. By taking park in the sessions you agree and acknowledge that:
(i) You and your child are aware of the inherent element of risk involved in the sport and you accept responsibility exposing yourself to such inherent risk whilst taking part in the session;
(ii) You and your child will comply at all times with the instructions of the OOD and / or instructors, particularly with regard to handling of boats, wearing of buoyancy aids and the wearing of suitable clothing for the conditions;
(iii) You and your child accept responsibility for any injury, damage or loss to the extent caused by your own negligence;
(iv) You and your child will not participate in the session whilst your ability to skipper or crew a dinghy is impaired by alcohol, drugs or whilst otherwise unfit to participate;
(v) The provision of patrol boat cover is limited to such assistance, as can be practically provided in the circumstances;
(vi) You and your child are aware of any specific risks drawn to your attention by the Open Day OOD / instructor;

(vii) You and your child understand that the Club provides rescue facilities, supervision and control only during the sessions.
(viii) The minimum age for taking part in a training course or WJS is 8 years old.
 
CLOTHING
I undertake to ensure that he/ she will attend the Royal Lymington Yacht Club activities suitably clothed, with long hair tied back.
 
WATER CONFIDENCE
I declare that the above named is water confident.

 
CANCELLATION
You understand that the Club may cancel or postpone the session at any stage in the event of bad weather, equipment failure or otherwise.
 
MISCONDUCT
You understand that the Club may exclude anyone from a particular session and evict anyone from the premises.
 
PHOTOGRAPHY
I understand and agree that my child may be photographed or filmed by the Club or its agents and the images used for promotional or training purposes and waive any copyright.

 
DATA DECLARATION
I understand that the Organising Authority will hold and use my personal data for the purpose of the event. Further information can be found in the Club's privacy statement. 

 

Accept Terms & Conditions
 Security code
Date:
Now