Skip to content

Junior Membership

KCPC Junior Membership

FORM (UNDER 18’s)

Child’s Name
Child's Name
First
Last
Parent / Guardian
Parent / Guardian
First
Last
Are you available to Volunteer?
Child’s Medical conditions (Any Disability/Medical Condition the Club should be aware of?)

INDEMNITY STATEMENT

The signatory, agrees to abide by the rules and regulations outlined in Kilcock
Canoe Polo Club. In consideration of and through my involvement with Kilcock Canoe Polo Club, I
hereby acknowledge and agree to release the Club and its agents from any and all liabilities which
might result from my involvement in the Club.

The signatory, give my permission for Kilcock Canoe Polo Club, to take
Photographs/use video camera equipment of training/competitions from time to time, to be publish
on our social media platforms to promote our club.

Please upload your e-signature or download the indemnity forms and scan to :[email protected]

Maximum file size: 268.44MB

I give KCPC permission to pass on my information to Canoeing Ireland to be signed up to the database. We have your details
on file with the purpose of using it to provide you with relevant canoe polo information and any details required for
Volunteering.