Family membership

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BREADALBANE CANOE CLUB

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Please complete all sections for each family member unless information is the same as first family member. Family membership includes 2 adults and up to 4 children.

First Name

Last Name

Address

Email

Phone

Date of Birth

Emergency contact name, relationship and phone number

SCA number (if applicable)

Do you have any medical conditions? *

No

Yes

If yes, please add details and any medication needed.

Do you have any allergies? *

No

Yes

If yes, please add details and any medication needed.

Please complete. *

swimmer

non swimmer

Beginner paddler

Intermediate paddler

Experienced paddler

Down to Next Page

Add 2nd family member

First Name

Last Name

Address

Email

Phone

Date of Birth

Emergency contact name, relationship and phone number

SCA number (if applicable)

Do you have any medical conditions?

No

Yes

If yes, please add details and any medication needed.

Do you have any allergies?

No

Yes

If yes, please add details and any medication needed.

Please complete.

swimmer

non swimmer

Beginner paddler

Intermediate paddler

Experienced paddler

Down to Next Page

Add 3rd family member

First Name

Last Name

Address

Email

Phone

Date of Birth

Emergency contact name, relationship and phone number

SCA number (if applicable)

Do you have any medical conditions?

No

Yes

If yes, please add details and any medication needed.

Do you have any allergies?

No

Yes

If yes, please add details and any medication needed.

Please complete.

swimmer

non swimmer

Beginner paddler

Intermediate paddler

Experienced paddler

Down to Next Page

Add 4th family member

First Name

Last Name

Address

Email

Phone

Date of Birth

Emergency contact name, relationship and phone number

SCA number (if applicable)

Do you have any medical conditions?

No

Yes

If yes, please add details and any medication needed.

Do you have any allergies?

No

Yes

If yes, please add details and any medication needed.

Please complete.

swimmer

non swimmer

Beginner paddler

Intermediate paddler

Experienced paddler

Down to Next Page

Add 5th family member

First Name

Last Name

Address

Email

Phone

Date of Birth

Emergency contact name, relationship and phone number

SCA number (if applicable)

Do you have any medical conditions?

No

Yes

If yes, please add details and any medication needed.

Do you have any allergies?

No

Yes

If yes, please add details and any medication needed.

Please complete.

swimmer

non swimmer

Beginner paddler

Intermediate paddler

Experienced paddler

Down to Next Page

Add 6th family member

First Name

Last Name

Address

Email

Phone

Date of Birth

Emergency contact name, relationship and phone number

SCA number (if applicable)

Do you have any medical conditions?

No

Yes

If yes, please add details and any medication needed.

Do you have any allergies?

No

Yes

If yes, please add details and any medication needed.

Please complete.

swimmer

non swimmer

Beginner paddler

Intermediate paddler

Experienced paddler

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