Membership Form

Only use this form if you are aged 18+ and a current member of the club.

All information will be forwarded to the club membership secretary only and stored confidentially. Leicester Rowing Club will hold the information provided on this form electronically. It will only be used to contact you about LRC matters; it will not be provided to any third party or other organization.

Personal Information

Title *

Your Name *

Gender *

Date of birth *

Address *

Postcode *

Phone *

Email*

Emergency Contact Details

Name of Contact *

Relationship to Participant *

Emergency Contact Number *

Membership category

Class of Membership *

Payment Method *

Swimming Ability

Swim 50 meters in light clothing
YesNo

Swim 5 meters underwater in light clothing
YesNo

Tread water for 2 minutes in light clothing
YesNo

I have done a capsize drill
YesNo

Health Questionnaire

Do you suffer from any long-term health condition *
YesNo
If Yes, please provide details

Do you suffer from any other condition that may affect your ability to row safely *
YesNo
If Yes, please provide details

Do you have any health condition, impairment or disability of which Leicester Rowing Club should be aware? *
YesNo
If Yes, please provide details

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