Hinksey Sculling School

Application Form

Hinksey Sculling School-Active Membership Application Form – September 2008

This form must be accompanied by a cheque/cash in the sum of £10 made out to “Hinksey Sculling School Ltd.” being the non refundable Entrance Fee (See Rule 6). If, after the “taster” (See Rule 6), the applicant wishes to become a Full Active Member an annual fee of £50 falls due. Additionally water coaching fees apply as follows:- £130 per annum for all athletes learning on the Lake.. On transfer to the river, for athletes aged under 12 on the 1st of September the fee will be £175 per annum, athletes over 12 and under 14 on 1st September will be charged £220 per annum and athletes over 14 on 1^st September will be charged £250 per annum. An invoice will be sent to the 1^st. Associate below. (See Rules 6 & 7).

Active Member(Capitals)____________________________________________________________________

Date of Birth_________________Sex_________________Wt (Kgs)_____________________________

 

1^st Associate  (Capitals)______________________________________________

2^nd Associate (Capitals)______________________________________________________(See Rule 3B)

I hereby consent to any data held by Hinksey Sculling School being used (even if involving disclosure) for any reasonable purpose of Hinksey Sculling School Ltd. including use on training videos and publicity.

1^st Associate Signature                                                                                              Date   

Parent/Guardian who must authorise this application by signing here. (See Rule 3B)

Address:- (This will be used for all correspondence regarding the Active Member)

1^st Associate's Occupation_____________________________________________________________

2^nd Associate’s Occupation_____________________________________________________________

Home Telephone No   ___________________________     Work telephone………………………………

PRINCIPAL e-mail address for all club correspondence including the submission of invoices:-

ALTERNATE e-mail address. In all instances where the Active Member is allowed direct access to her/his own e-mail address all e-mails regarding Training and Competitions will be copied to Her/Him.

School attended by Applicant……… …………………………………………………

Emergency Contacts with telephone numbers:-

(eg Grand Parent/Neighbour etc)

Detail of any medical condition that HSS coaches need to be aware of should be recorded here along with relevant information not requested overleaf.

Known Medical Conditions:- NO / YES       If yes please provide full detail:-

Doctor’s Name_______________________Doctor’s Telephone No.______________

This form should be returned to John Broadhurst, Chairman, Hinksey Sculling School, The Barn, Thrupp, Kidlington, Oxford. OX5 1JY                                    

Tel 01865 842552   Fax 01865 842552 E-Mail john@hinkseysculling.org.uk

Hinksey Application Form.doc (revised September 2007)

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