2015 MCRA Release - Merrymeeting Community Rowing Association

Merrymeeting Community Rowing Association MCRA Required Information 1. I have watched the USRowing Safety Video (http://www.usrowing.org/Safety/SafetyVideo.aspx).
2. Swimming Requirements: •
Learn to Row participants must attest to their swimming ability by responding to the following item: I am over the age of 18 and am certain that I can successfully complete the following: • Swim at least 50 meters wearing light clothing • Tread water for at least two minutes • Swim underwater (fully submerged) for at least Iive meters • Put on a life jacket in the water ______________ I am going to be a Learn to Row participant and I am certain that I can complete the swimming requirements listed above. (Participation beyond a Learn to Row class requires completing a supervised swim test.) ______________ I am not certain I can complete the swimming requirements listed above. I understand that to row with MCRA I must wear a life jacket when on the water. New Participants joining the MCRA after 2014 (except for people who are only taking a Learn to Row class) and all participants under the age of 18 must take a supervised swim test. 2. Medical: (Please read the attached “Physical Activity Readiness” form.) •
Do you have any medical conditions or concerns (including ones not mentioned on the Physical Activity Readiness form) that might affect or be affected by your participation in a strenuous activity such as rowing? YES/NO (Please circle one) •
Are you over 69 years of age? YES/NO (Please circle one) •
If you answered “Yes” to either of the above questions, have you contacted your physician and been cleared to participate in rowing? YES/NO (Please circle one) 3. Describe any medical conditions or concerns that could affect your participation: 4. Person we can contact in case of an emergency: ___________________________________ Emergency Contact Name ________________________ Phone __________________________ Relationship 5. May we have your permission to share your phone number and email address with other MCRA rowers? It can be helpful to be able to call another rower if one of you has to cancel a practice at the last minute, is running later, etc. YES/NO 6. May we have your permission to photograph and/or record you on video. The photos/video may be shared with prospective rowers so they can understand what rowing might be like or may be posted to our website or YouTube channel, shown at open houses, etc. for the same reason. YES/NO By signing this form you are certifying that you have watched the USRowing Safety Video and provided complete and accurate responses to all questions on this form. _________________________________ Participant’s Signature ______________ Date _________________________________ Participant’s Printed Name _________________________________ Parent Signature (if required)
PHYSICAL ACTIVITY READINESS
Regular physical activity is fun and healthy and more people are starting to become
increasingly active every day. Being more active is safe for most people. However, we
strongly encourage people to check with their doctor before they start rowing or
becoming increasing physical activity.
If you are between the ages of 15 and 69, this Physical Activity Readiness Questionnaire
will offer some degree of guidance about physical concerns that may indicate that it is
imperative for you to consult a physician before you start rowing. If you are over 69
years of age and you are not used to being very active, please check with your doctor
before doing any MCRA activities.
Common sense is your best guide when you answer these questions. Please read the
questions carefully and give an honest "yes" or "no" answer to every question:
-
Has your doctor ever said that you have a heart condition and that you should
only do physical activity recommended by a doctor?
-
Do you feel pain in your chest when you perform physical activity?
-
Have you had chest pain when you were not doing physical activity in the past
month?
-
Do you lose balance because of dizziness or do you ever lose consciousness?
-
Do you have a bone or joint problem that could be made worse by a change in
your physical activity?
-
Is your doctor currently prescribing drugs (for example, water pills) for your
blood pressure or heart condition?
-
Do you know of any other reason why you should not perform physical
activity?
If you answered "Yes" to one or more questions above
Consult your doctor by phone or in person before you start rowing, becoming
much more physically active or, have a fitness appraisal. Tell your doctor about
this questionnaire and which questions you answered yes to.
You may be able to do any activity you want - as long as you start slowly and
build up gradually. Or you may need to restrict your activities to those that are
safe to you. Speak to your doctor about rowing, lifting and carrying boats, etc.
and the kinds of activities you wish to participate in and then follow the advice
given.