Powerboat Level 2 Adult consent form Please enable JavaScript in your browser to complete this form.Name *FirstLastContact Number *Email *Date of Birth (required to register your certificate with the RYA) *Emergency Contact's Name *FirstLastContact Number *RYA Membership Number (if you have one)Date of Course *Have you suffered or have from any of the following conditions?AsthmaFitsHeat diseaseFainting/BlackoutsDiabetesSevere HeadachesIt is your responsibility to make known any disability/medical condition that may affect you during the activity, and any medication that they may require. This information will be shared with those responsible for supervising the activity.Do you have any allergies or any other medical conditions we should know about?If you have an allergy please tell us what you are allergic to.Are you currently suffering/recovering from any injuries which may affect their ability to drive a powerboat? *YesNoI have read the statement below and give my consent *YesNoI give permission to administer any relevant treatment or medication to the above-named participant when or if necessary. In an emergency situation I authorise the organisers to take you to hospital and give my full permission for any treatment required to be carried out in accordance with the hospital’s diagnosis. I understand that I shall be notified, as soon as possible, of the hospital visit and any treatment given by the hospital. I have read the statement below and give my consent *YesNoBoating is by its nature an unpredictable activity and therefore inherently involves an element of risk. By participating in the training I agree and acknowledge that: 1. I am aware of the inherent element of risk involved in the sport and accept responsibility 2. I have satisfied myself that I have the necessary skill and knowledge to take part in the training and to deal with conditions that may arise on the course 3. I will not participate in the training whilst under the undue influence of alcohol, drugs or whilst otherwise unfit to participate 4. I am responsible for my property whether afloat or ashore; 5. I accept responsibility for any injury, damage or loss to the extent caused by my own actions or omissions. If any injury is sustained during the course I will inform the instructor immediately. I have read the statement below and give my consent *YesNoI grant to the organisers without payment the right in perpetuity to make, use and show any motion pictures, still pictures and live, taped or filmed television of or relating to the training. I have read and understood the Conditions of Use I agree to notify the Club of any relevant changes in my circumstances. Conditions of Use of photography or video In accordance with our Data protection policy, Chichester Boat Club will not arrange for photographs, video or other images to be taken or published without your consent. We will abide by the Conditions of Use below. If you have any concerns about the way images are being used, you should inform the Club immediately. 1. a) We will normally only identify you by reference to your first name. 2. b) We will not use personal details or full names (i.e. first name and surname) accompany a photographic image on video, on our website, in our organisation brochure or any other electronic or printed publications. 3. c) We will not include personal email or postal addresses, telephone or mobile numbers on video, on our website, in our organisation brochure or in other electronic or printed publications. 4. d) We may use group photographs or video with very general labels, such as ‘Power boat Training day’. 5. e) We will only use images of people who are suitably dressed, to reduce the risk of such images being used inappropriately. 6. f) Photographs or video may be used for coaching purposes or by officials during competition to illustrate incidents on the water. 7. g) Commercial sale of any form of media will be limited to the organisers or their official photographers. NameSubmit Consent Form