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Water Works Canoe CompanyMansfield Center, CT 06250The Bag Lady -nobody does it better!Phone 860-456-4906 email: baglady@charter.netThe Bag Lady also makes canoe top covers! |
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Columbia Canoe Club, Inc. Membership Application and Renewal Form- Only needed if information has changed. BUT EVERYONE MUST COMPLETE a new ACA (American Canoe Association) waiver and submit IT yearly. Your application can not be processed until all paperwork is complete.
Date Completed:______________________ New:___________ Renewal:__________ Name:________________________________________ Date of Birth:______________ Address: _______________________________________________________________ Address 2: ______________________________________________________________ City:_______________________________________________ State_______________ Home Phone:________________________ Emergency Number:_________________ Email:____________________________________________ (will not be publicized) Membership runs from April 1- through March 31 of following year regardless of when received. _____ Check here if you are willing to let us release your phone number to other club members so they can contact you about paddling events or opportunities to paddle. It will not be released for other reasons. __________ If you would prefer to be contacted by email, check here. __________ We recommend checking with a physician prior to participating in this or any physical activity. Do you have any medical condition / and or a prescribed medication that may impact on water activity of which we should be aware? Please describe below, use back if needed. ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Any sport has an element of risk and paddling is no different. I assume foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death. I agree to wear my lifejacket when using club equipment during on water activities. I will not paddle alone. _____________________________ ___________________________________ Printed name of applicant (clearly please) Signature of applicant _________________________________ _____________________________ Printed name of parent if minor Signature of parent if minor February 2010 |
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Nobody does it better than the BAG LADY. OVER 30 YEARS OF MAKING BAGS!!!! |
