NYRC Consent Form

NOOSA YACHT & ROWING CLUB
CONSENT FORM AND DEED OF RELEASE
As Parent/ Guardian of (Childs name)........................................................................(•the member")

Members Childs Date of Birth ........../........../...........

I/We (Parent/s Name/s):............................………………………………...................….... give my/our consent for the member to participate in the sport of sailing/rowing and further agree to delegate my/our parental authority to the instructors/coaches involves with the members in pursuing the sport. In consideration of my/our child being allowed to participate in sailing/rowing. I/we including my/our lawful heirs, successors hereby waiver all and any claim, right or cause of action which I/we or the member may have arising out of injury, damage, loss of life, of any description whatsoever which I/we and/or the member and/or a third party may suffer or sustain in the course of or consequence upon the member participating in the sport of sailing whether such injury, damage, loss of life or other loss is caused by the negligence, breach of contract or direct trespass or any other of a teacher, coach, parent, volunteer, the member or any other student or person. This release shall operate separately in favour of all persons, corporations or other bodies involved or otherwise engaged or participating in the sport of sailing/rowing or the coaching of sailing/rowing including the Noosa Yacht & Rowing Club Inc. or any member of such association or club.

I/we acknowledge and agree that the sport of sailing/rowing can be a dangerous activity and involves some element of risk including but not limited to unusually severe weather, acts of God, failure of equipment or machinery, accidents or collision of craft I/we on my/our own behalf and for and on behalf of the member voluntarily accept all and any such risk whether or not it is caused directly or indirectly by a torious act or omission of a teacher, coach, parent, volunteer, other member or other person including the Noosa Yacht & Rowing Club Inc. or any member or members thereof.

I/we agree that the teachers, coaches may take whatever disciplinary action they deem necessary to ensure the safety, well being and successful conduct of the members as a group, or individually, in the above mentioned activities. I/we authorise the teachers and/or coaches to obtain medical assistance, which they deem necessary should an accident or injury occur, and agree to pay all medical expenses incurred on behalf of the member. I/we further authorise qualified practitioners to administer an anaesthetic if such an eventuality arises.

I/we submit the following medical information about the member and include details of limitations which he/she has for the activity concerned. (If there is not enough room to write all details of the members medical history please supply separate sheet to include any extra details.)

Dated this: . ...............................................day of (month/year)..........................................................
SIGNED SEALED AND DELIVERED (To be Signed in the presence of a Club Official)

(Parent/Guardian………………………………………………………………………………

(Witness/Position………………………………………………………………………………
PLEASE PRINT NAME IN BLOCK LETTERS………………………………………………………………………………

MEDICAL INFORMATION: Is there any medical or psychological reason to prevent your child from participating in the sport of sailing/rowing outlined in the information sheet below: YES

/ NO

If yes give details:

IN AN EMERGENCY CONTACT:

(Name)………………………………………………………………….. Telephone:………………………

	Please tick as required			Please tick as required
HEART PROBLEMS	YES	NO	RESPIRATORY PROBLEMS	YES	NO
ALLERGIES	YES	NO	TRAVEL SICKNESS	YES	NO
BLOOD PRESSURE	YES	NO	OPERATIONS	YES	NO
EPILEPSY	YES	NO	RECENT ILLNESS	YES	NO
DRUG REACTION eg Penicillin	YES	NO	Phobias	YES	NO
OTHER	YES	NO