Stronger Together Expression of Interest Form-Ripple Rebels CIC

We are now heading into winter weather. its cold but the conditions could be perfect for paddling. Let us know if you would like to join us during the following months:

If you cant make any of these sessions, when are you available?

First Name

Last Name

Age

Phone Number

Email

Are you bringing a parent, partner, friend or carer to paddle with you?

Emergency contact name and relationship to you

Emergency contact phone number

Health and wellbeing. Please check those that apply:

Significant injury over the last 3 years

Receiving treatment for a medical condition

Taking prescribed medicine (bring with you on the day)

A disability or physical restriction that you will need support and adaptation for

Other physical or mental health issues we should be aware of so we can offer you our best support

None of the above

Please add and additional information

Information about your mobility

Wheelchair user

Walker or other mobility equipment

Independently mobile

Access to the water is via a gently sloping slipway. The paddleboard can be positioned very close to the water. What support will you need to get onto a paddleboard?

I will need someone to guide me onto the board

I will need some help with the transfer - 1 person

I will need considerable help with the transfer - 2 people

I am unable to transfer without full support - lets discuss

None, I can independently transfer to a paddleboard

What is your approximate weight in kg?

What is your approximate height in cm's?

Can you sit unsupported?

Yes

No

With difficulty

Can you kneel unsupported?

Yes

No

With difficulty

Would you like to add any further detail about sitting or kneeling?

Have you had any experience of being on or in the water? What type of activity?

What would you like to achieve with Ripple Rebels?

Try paddleboarding out, not sure where this could go!

Paddleboard with friends and family

Find a social group of paddleboarders

Paddle independently on a lake

Paddle independently on a river

Paddle independently on the sea

Get competitive, build my skills and maybe even race

Is there anything else you would like to achieve with Ripple Rebels?

How far can you comfortably swim unaided?

We have all the kit you will need to paddleboard with us. If you have your own please do bring it with you so that we can adapt it to your needs. If the conditions require use of a wetsuit we have junior to plus size available.

Please tick the kit you will bring with you

I declare that I am fit and well and will abide by the advice and guidance of the instructors..

I have not been exposed to and is not showing signs of COVID19, will abide by the 2m social distancing rule and will wear a mask indoors unless exempt.

I consent for the use of pictures in social media posts promoting the work of RIPPLE REBELS CIC and INCLUSIVE PADDLEBOARDING. These photos will not be shared with any other parties and will be removed at your request.

I understand that the information I have given will be held in accordance with the data protection Act 1998 but may also be made available to insurers and other concerned parties in the event of any injury or accident.

I agree to the terms & conditions