READINESS to SUP Assessment

Readiness to SUP Assessment
Nb : If you are completing this form on a Smart Phone or Tablet, turning it to landscape mode may help
Participant Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number
Birth Date:

MonthDayYear
Emergency Contact Details
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Relationship to you
Medical Information
Do you have a disability?
If Yes - please give details below
Details (if required)
Do you have any medical conditions of which we should be aware?
If Yes - please give details below
Details (if required)
Do you have any allergies?
If Yes - please give details below
Details (if required)
Please give any other details that may be relevant to your participation in this activity:
Safety and Risk Declaration
This part of the form is intended to make you aware of the risks associated with Stand Up Paddle Boarding (SUP) and to help you make and informed decision as to whether to participate. Signing this form does not (and is not intended to) limit our obligations to you and does not in any way compromise your legal rights. Stand Up Paddling is an “Assumed Risk” and “Water contact sports” that may carry attendant risks. Participants should be aware of and accept these risks and be responsible for their own action and involvement.
Section 1 - I understand that the activities I may participate in will expose me to many hazards and involve the risk of property damage and loss and even personal injury, illness or death. Whilst Sup-Wales will take all reasonable steps to ensure my safety, I understand that they cannot be held liable for my own actions, for which I must take responsibility, or for those of a third party.
Section 2 - I do not have any medical conditions or illnesses other than those disclosed in this form. Despite these conditions I am sufficiently fit, able and competent to paddle and participate in all the activities.
Section 3 -I am a confident swimmer
Section 4 – Entry and Exit is only available through the designate areas identified by the instructor’s reception and equipment through the Instructors
Section 5 - I understand that whilst Sup-Wales will provide me with help and advice whenever they can, I will only receive instruction in the use of equipment or techniques when I have booked and paid for such instruction. I will not participate in any activity unsupervised if I am not confident and capable in the use of any of the equipment or area I am paddling.
Section 6 –I will ensure that I have been informed about the Water Quality by the instructor and understand the Water Quality Information.
One last thing.

In order for us to get you on the water quicker we try and get your Buoyancy Aid ready for you.

Therefore please select the size of clothes you normally wear below.

That will give us a good indication of what Buoyancy Aid you need.
Buoyancy Aid Size
Signatures
Signed - eSignature
Signed - Date

MonthDayYear
We will always store your personal data confidentially and securely. We require your data in the event that we need pass on any information regarding your booking or membership. It will not be sold to a third party or used for promotional activities unless we have your consent.
Keep in touch
Should be Empty:

Readiness to SUP Assessment

Participant Information

Emergency Contact Details

Medical Information

Safety and Risk Declaration

Signatures