Registration form Wageningen
Kayak and Canoe Club "De Bovenste Polder"

Please address to :
WKV De Bovenste Polder
Wim Sonneveldstraat 22
6708 NB Wageningen
The Netherlands

I wish to register as a member of the Wageningen Kayak and Canoe Club "WKV De Bovenste Polder".

NAME + INITIALS : ______________________________
CALL NAME: ______________________________
STREET +NR: ______________________________
ZIP CODE + CITY: ______________________________
E-MAIL ADDRESS: ______________________________
TELEPHONE: ______________________________
DATE OF BIRTH: ______________ SEX: M / F*
I DO / DO NOT* wish to hire a place for my own KAYAK / CANOE*.
I DO / DO NOT* wish to make use of a RENTAL CONTRACT for club kayaks.

*Please strike through what does not apply.

If you are also a member of an other kayak club affiliated with the Dutch Water Sport Federation ("Watersportverbond", WSV), please fill in the name of the other kayak club and also the WSV membership number:

The undersigned declares:

  1. To be able to swim,
  2. To practise the kayak sport at his/her own risk,
  3. To safeguard the kayak club against the responsibility for any damage to personal properties.

Date: __________________________ Signature: _________________________