Health Declaration Form (Hire)

This page gives the text of the form you will be asked to fill out if you are over 16 and hiring a craft from Colwyn Bay Watersports.

Health Declaration Form (Hire)

Name of Participant (Print):

Name of Emergency contact ashore (Print):

Number/details of contact ashore (Print):

Health Declaration statement:

I am over 16 and hereby knowingly agree that the participation in Watersports activities with Colwyn Bay Watersports is potentially strenuous and declare that I am physically fit and able to participate in these activities. I also consent to be photographed and I’m aware this photograph may appear in Colwyn Bay Watersports promotional material.

I am healthy and free from all medication and injury.                                                          

 Yes                No

I consent to be photographed and I’m aware this photograph may appear in Colwyn Bay Watersports promotional material.

Yes                         No 

 If Yes: Please sign below.

If No: I have made a member of Colwyn Bay Watersports staff aware, who has told me the “Duty Senior” is aware of any and all injuries and ailments that may be of concern, inhibit or prevent participation or cause further injury during activities on the water. This will enable Colwyn Bay Watersports staff to take appropriate steps to enable me to access the Watersports activities, in line with the Colwyn Bay Watersports safety system. I have given details of my condition in the box below and I confirm my understanding of this form by signing below. If I do not consent to be photographed I have made this clear in the box below.

I will ensure I have been given a safety brief and shown how to attract attention on the water before launch 

Yes           

I will ensure I have been shown the area in which I am allowed to operate the craft I have hired before launch. 

Yes       

I am confident and competent in the craft I have hired and I agree to follow the directions of all CBW staff.

Yes 

I accept that the Duty Senior’s word is final and that their decision is made in the interest firstly of health and safety, and secondly the enjoyment of all participants.

Customer Signature:                                                          Date:

Staff Member (Print):

Staff Member’s Signature:                                                Date:

Brief description of any Medical Condition that the Waterfront should be aware of:

 

Please return to the Colwyn Bay Watersports staff when completed.