Fort Langley Youth Rowing Society

Please provide all requested information. Note that all areas must be filled in to complete registration

Participants Name

Parent Name

Address

City

Postal Code

Parents Email (used to contact)

Parents Home Phone Number #1

Parents Cell Phone Number #2

Rowers Email

Rower's Cell Phone Number

Birth Date

Sex

Male
Female

Fee Payment Rules (Post Dated or Annual)

**** PLEASE SCROLL THROUGH ENTIRE SECTION FOR ALL FEE PAYMENT OPTIONS AND REFUND POLICY ****
Fees are to be paid by postdated cheque on an annual or postdated basis as outlined below.
Post Dated payments as follows:
Due Date:                                      Amount Due:
1) September 1, 2023                    $400              
2) November 1, 2023                     $400   
3) January 1, 2024                         $400 
4) March 1, 2024                            $400

2022 - 2023 Annual Membership Fee:
Due Date:
September 1, 2022   Amount Due:  $1600

Payment Options:

1) By Cheque - Please make cheques payable to Fort Langley Youth Rowing Society. Cheques must be mailed to the address below directly following the completion of this form. Please address the mail to The Registrar at P.O. Box 27, STN Fort Langley, Langley, BC, V1M 2R4.

2) By E-Transfer - Transfer money to flyrstreasurer@gmail.com with clue: What is our sport? and answer: ROWING

NOTE: Please include your child's full name and 'Club Registration Fees' in the envelope or in the notes section of the etransfer.

Refunds & Cancellations: Memberships are not transferable to short term programs or to other people. The FLYRS has a general no refund policy. The FLYRS Board of Directors may pro-rate or refund membership or program fees due to medical reasons with medical documentation or physicians note.

NOTE: In the event of a complete shutdown due to COVID-19, families may elect to resign from the FLYRS Club. In this case the family will receive a pro-rated refund based on fees paid to date. The Rower will not be allowed to rejoin the club until the following season.

Privacy Statement: All personal information given by participants will only be used for administration and regular communication with respect to the rowing programs. Your information will not be sold or given to anyone else with commercial intentions or otherwise.

Payment Choice

Postdated
Annually

Payment Options

Cheque
E-Transer

Notes:

EMERGENCY CONTACT INFORMATION

Parent/Guardian

Telephone: Day

Telephone: Cell

Email

Parent/Guardian

Telephone: Day

Telephone: Cell

Email

Emergency Contact's Name: (Other than parents)

Relationship to Rower

Phone #

Cell Number

Click to enter text

MEDICAL INFORMATION

Care Card #

Date of last tetanus immunization

Family Physician

Telephone

Medications taken on a regular basis

Allergies

Medical conditions currently under treatment

Pre-existing physical conditions under treatment

Contact Lenses or Glasses

yes
no

Any other notes that may be of assistance to coaches and/or chaperones:

COVID-19 Athlete Waiver

I have read, understand and agree to abide by the COVID 19 Waiver

I hereby give permission for the Fort Langley Youth Rowing Society to be responsible for providing medical supervision and treatment of my child if required.

Yes, I agree to these Terms
No, I do not agree to these Terms

RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

IN CONSIDERATION of and for the Fort Langley Youth Rowing Society (“FLYRS”) permitting me to participate in rowing programs,
rowing activities, events and any other activities on water or on land that FLYRS organizes, sponsors, attends or otherwise participates
in (the “Rowing Activities”), and to use the facilities and equipment available through FLYRS, I, the undersigned, for myself, and, in the
event of my death or incapacity, my heirs, next-of-kin, executors, administrators and representatives, agree with FLYRS, its directors,
officers, agents, employees, coaches, contractors, members, volunteers, other participants in the Rowing Activities, regatta organizers,
sponsors, advertisers and owners and lessors of any premises on which any of the Rowing Activities takes place (collectively the
“Releasees”) as follows:
I WARRANT AND REPRESENT, both now and throughout my participation in the Rowing Activities, that:
1. I understand that rowing shells are unstable and not designed for use in rough water conditions and that rowers’ face away from the
direction in which they are rowing. I understand the nature of the Rowing Activities, whether occurring on water or land, and that the
Rowing Activities involve danger and the risk of serious bodily injury, including but not limited to partial or permanent disability;
paralysis; death; and other risks, such as social or economic loss, either unknown or not foreseeable now (collectively the “Risks”).
I further understand that the Risks may arise from dangers including, but not limited to, the physical exertion involved in the Rowing
Activities; carrying boats; placing boats in and lifting them out of the water and storage locations; collision with another boat, or a
floating or stationary object; equipment malfunction; capsizing; swamping in waves caused by passing vessels or adverse weather;
hypothermia; hyperthermia; and drowning.
2. I understand that my own action or inaction, the action or inaction of others, the conditions in which the Rowing Activities take place,
or the negligence of one or more of the Releasees may expose me to danger and the Risks.
3. I am in good health and am medically fit for participation in the Rowing Activities. Without limiting the generality of the forgoing, I do
not suffer from a heart condition or other ailment that participation in the Rowing Activities could aggravate. Further, either I am able
to swim 50 meters immediately after which I can tread water for 10 minutes, or I hold the Bronze Cross/Medallion in swimming, or
both.

I AGREE THAT:
1. I will at all times obey all safety rules established by FLYRS.
2. I am responsible for my own safety and will participate in the Rowing Activities within the limits of my abilities. At any time I believe
any of the Rowing Activities or the conditions in which that activity is taking place are unsafe or beyond my abilities, I will immediately
cease to participate in that activity.
3. I fully accept and assume the Risks and full responsibility for all injury, damages, loss and costs I may suffer arising from my
participation in any of the Rowing Activities.
4. I will indemnify, save and hold harmless the Releasees from any and all liability for any property damage or personal injury to the
Releasees or any of them, or to any third party, resulting from my participation in the Rowing Activities.
5. If, despite this Agreement, I or anyone on my behalf makes a claim against the Releasees or any of them, I will indemnify, save
and hold harmless the Releasees and each of them from any liability, claims, demands, loss, damages or costs which they or any
of them may incur as a result of that claim.

I HEREBY WAIVE ANY AND ALL CLAIMS THAT I HAVE OR IN THE FUTURE MAY HAVE AGAINST THE RELEASEES AND RELEASE AND FOREVER DISCHARGE THE RELEASEES and each of them from any and all liability for any loss, damage, expense or injury, including death, that I or any of my next-of-kin may suffer arising from my participation in the Rowing Activities due, or alleged to be due, to any cause whatsoever, in whole or in part, including but not limited to negligence, breach of contract, breach of any statutory or other duty of care, including any duty under the Occupiers Liability Act, of the Releasees or any of them, and further including but not limited to failure on the part of the Releasees or any of them to safeguard and protect me from the Risks and the dangers of the Rowing Activities, and negligence in any rescue operations any of them may undertake.

I have read this Agreement. I fully understand its terms and that I have given up substantial rights by clicking this box. I intend it to be a complete and unconditional release of all liability.

Complete this part ONLY if Participant is under 19 years of age

I, the parent and/or legal guardian of the Minor Participant, understand the nature of rowing and the Rowing Activities and the Minor Participant’s experience and abilities. I believe that the Minor Participant is medically fit and able to participate in the Rowing Activities without limitation. I have read, understand and agree with the terms of the foregoing Agreement and will ensure that the Minor Participant fulfills the Participant’s obligations thereunder, and I HEREBY RELEASE AND FOREVER DISCHARGE THE RELEASEES and each of them from any and all liability, claims, demands and costs for any loss, damages, expenses or injury, including death, that the Minor Participant or any of the Minor Participant’s next-of-kin may suffer due, or alleged to be due, to any cause whatsoever, in whole or in part, including but not limited to negligence, breach of contract, breach of any statutory or other duty of care, including any duty under the Occupiers Liability Act, of the Releasees or any of them, and further including but not limited to failure on the part of the Releasees or any of them to safeguard and protect the Minor Participant from the Risks and the dangers of the Rowing Activities, and negligence in any rescue operations any of them may undertake. If, despite this Agreement, I, the Minor Participant, or anyone on the Minor Participant’s behalf makes a claim against the Releasees or any of them, I will indemnify, save and hold harmless the Releasees and each of them from any liability, claims, demands, loss, damages or costs which they or any of them may incur as a result of that claim.

I have read the above terms and, with clicking this box, agree to the terms set out above.

Safety Code

All registrants and their parents must review the following Safety Policy and return the signed form before the rower can participate in any
“on water” activity.

1) All registrants must be able to swim 50 meters in light clothing. Immediately after they must be able to tread water for 10 minutes and must be
sufficiently at ease in the water not to panic. By signing this form the registrant and their parent(s) acknowledge that this is true.

2) Training sessions will begin promptly, at the scheduled time. Coaches may decide not to boat rowers who arrive late. Coaches will not be
responsible for onshore supervision of late arrivals.

3) Each rower must have a whistle attached to their person prior to leaving the shore.

4) Rowers must not leave the dock until the coach/safety boat motor is running. They must not proceed beyond the pipeline signs or the bridge until accompanied by their assigned coach.

5) All rowers must be accompanied on the water by a coach, or approved substitute, in a coach/safety boat. Rowers on the water must remain within 300 metres of the coach/safety boat and stay in visual contact with the coach boat at all times.

6) Boats should stay in groups of two or more. If a partner’s boat capsizes, the “buddy” boat should ensure the capsized rower(s) are safe (back in
the boat or on shore) before going for help. Rowers should stay with the boat rather than attempt to swim to safety, however strong a swimmer a rower may be. The international distress signal is waving both arms over the head. Rowers should also use whistles to signal that assistance is required.

7) In the event that a crew must return to the dock, the crew must be accompanied by a coach. All other crews under the supervision of that coach must also return to the dock.

8) Rowers must familiarize themselves with docks and low bank waterfront landings in the training or racing area. In the event of a storm or other
unsafe conditions, rowers should immediately proceed to a safe landing area to get themselves out of the water.

9) Each coach must hold a valid Pleasure Craft Operator Card and must also hold a valid First Aid Certification – St. John’s Ambulance Safety
Oriented First Aid or its equivalent.

10) Each coach/safety boat must be equipped with the following items:

a) PFDs of the appropriate size for each crew member on board. The coach must wear a PFD and a motor “kill switch” must be attached to
the PFD and the motor;
b) PFDs of appropriate size for each member of the crew of the largest shell being attended;
c) a minimum of 5 warming blankets;
d) a First Aid Kit;
e) a buoyant heaving line of not less than 15 metres;
f) a watertight flashlight or a minimum of 3 emergency flares (Canadian approved of Type A, B or C);
g) a sound-signalling device or a sound-signaling appliance;
h) a bailer or pump;
i) one manual propelling device (e.g. paddle).

11) Each supervising coach must carry an operable cellular phone while rowers are on the 
water.

12) Each coach/safety boat will supervise a maximum number of 14 junior rowers in a maximum of 6 rowing shells.

13) Coaches are responsible for determining whether conditions are too dangerous to row due to darkness, fog, high winds, ice, cold water, storms or any other conditions which they determine may be of danger to the rowers. No rower shall be forced to row against his/her better judgement should conditions be questionable.

14) No morning rowing shall commence prior to daylight.

15) All boats must be off the water by sunset.

16) Rowing shall not take place in foggy conditions if visibility falls below 1000 metres.

I have read, understand and agree to abide by the Fort Langley Youth Rowing Society Safety Code.

PHOTO WAIVER

I, the parent and/or legal guardian of my child, do hereby grant permission for the Fort Langley
Youth Rowing Society to photograph and to publish the photographs of my child on the Fort Langley Youth
Rowing Society website and in related Fort Langley Youth Rowing Society promotional brochures, posters, and videos for the purpose of promoting the Fort Langley Youth Rowing Society. I also give permission for photos of my Child to be used in conjunction with newspaper articles submitted to or written by news media outlets. I
hereby waive all rights of privacy and/or compensation for my Child which he/she may have in connection with the use of his/her photograph or likeness in, or in connection with, said website, still photography, or film and
any use to which the same material may be put, applied or adapted by the Fort Langley Youth Rowing Society in connection with the promotion of the Fort Langley Youth Rowing Society. I release the Fort Langley Youth Rowing Society from and against any and all claims, liabilities or damages arising out of, or in connection with,
my Child’s photographs or likeness being used by the Fort Langley Youth Rowing Society for its promotional activities. I understand that my Child will not be identified by name in any promotional materials without further written consent.

By checking this box, I agree to the terms of the Photo Waiver.
I do not give Fort Langley Youth Rowing the authorization to use my child’s picture.

Any questions, comments, concerns?

FORT LANGLEY YOUTH ROWING SOCIETY

FLYRS Club Rowing Registration Form