Name: Thursday Evening Circuit
Start: 2023-02-02T17:00:00-05:00
End: 2023-02-02T18:45:00-05:00
Location: DHVTs VPF at FUMC

2023 Membership Application

Dragonheart Vermont membership runs from Jan 1 - Dec 31.

Dragonheart Vermont strives to strengthen and empower breast cancer survivors & supporters through the challenging sport of dragon boating instilling in its members the values of teamwork, fitness & community giving.

Questions? Please email [email protected]

Step 1 of 2

Personal Information
Legal Name(Required)
First Last
Nickname (optional)
Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Cell Phone(Required)
Email(Required)
Note: We collect your email for membership mailings / newsletters via MailChimp.
Contact Information Privacy
Please be aware that your coach(es) will have access to your date of birth and the above contact information.
- I consent to share the above contact information with other DHVT members
Dragonheart Vermont (DHVT) affirms and promotes participation in all of its activities without regard to race, color, sex, disability, affectional or sexual orientation, gender identity or expression, age, or national origin. Crew determination and eligibility, however, requires disclosure of gender and age. See Crew Determination section below for more information.
Please select any that may apply:
- Cancer Survivor (other than breast cancer)
- Breast Cancer Survivor
- Stage 4 Metastatic BCS
- BIPOC (Black, Indigenous, People of Color)
- New Paddler
NOTE: First-time paddlers will take 2 mandatory beginner sessions. The head coach and receiving coach will then determine your preparedness to transfer to your preferred crew(s).
Please list any special circumstances that coaches and trainers need to be aware of to make a reasonable accommodation for you to safely participate in our fitness programs.
Annual Membership Dues
Membership runs January 1 - December 31.
See Membership Benefits section for more information.

Membership types:
• Paddler: You plan to paddle at practices. Races and mini-camps are optional for paddlers and may be at an additional cost.
• Non-Paddler: You do not plan to paddle but continue to enjoy the camaraderie and positive community impact afforded by being a DHVT member. You can upgrade to Paddler at any time.
• Youth / Student: Qualification: Enrolled in school and between the ages of 14 and 24. Races and mini-camps are optional and may be at an additional cost.
• Stage 4 BCS Metastatic: Qualification: Classified with advanced (stage 4) breast cancer. Stage 4 Metastatic breast cancer is when cancer cells have spread from the breast to other parts of the body. Races and mini-camps are optional and may be at an additional cost.
• Team Coach: Qualification: Approved by DHVT’s Head Coach to be steering and/or coaching a crew this season.
• Lifetime Member: Qualification: Awarded by the DHVT Board of Directors for his / her commitment to the organization.
• Associate Paddler:Qualification: A paddler who is a member of another dragon boat team and who will compete with DHVT in national or international competitions when their primary team is not participating. You can choose to pay the full membership fee (by selecting "Paddler" at checkout) if you are so inclined. See full rules and paperwork requirements here.
• Senior D Paddler:Qualification: Age of 70+. May attend no more than 1 weekly practice with the Sr D coach. Races and mini-camps are optional for paddlers and may be at an additional cost. NOTE: A minimum of 8 Sr D members are needed by the first week of practice, otherwise, we will ask you to select another membership type.
• Post Festival Member (available for purchase after August 6, 2023):Qualification: A first time DHVT paddler joining after the Lake Champlain Dragon Boat Festival. Members have access to all DHVT benefits beginning the Monday after the first weekend in August and are not eligible to participate in 2023 USDBF National and World competitions.
Select Your Membership Type(Required)
- Paddler ($250)
- Associate Paddler ($125 or $250)
- Non-Paddler ($100)
- Senior D (70+) ($100)
- Youth/Student (14-24) ($25)
- Sisters for Life ($10)
- Stage 4 BCS Metastatic (free)
- Team Coach (free)
- Lifetime Member (free)
Crew Determination
The United States Dragon Boat Federation (USDBF) determines racing crews by gender, age and special interest groups. Special interest groups include BCP (Breast Cancer Paddlers) and ACP (All Cancer Paddlers). Dragonheart Vermont follows the USDBF criteria for team placement. Click here to view the different dragon boat racing classifications.
Date of Birth(Required)
Will be shared with team coaches (for team placement).
Month
Day
Year
Gender(Required)
Used for team placement and compliance with USDBF and IDBF policies on single and mixed gender crews.
Select Your Crew Preference(s)(Required)
Dragonheart Vermont will attempt to accommodate your preference(s) below. Regardless of your qualifying for special interest group crews, selection(s) will be determined by the Head Coach and team coach(es) based on your preference(s), fair fitness testing, your commitment through attendance and participation and some age-based parameters.
For example, a Breast Cancer Survivor can certainly paddle on another crew rather than with the BCP crew with approvals by the Head Coach and team coach.
You may indicate your interest in paddling with more than one crew.

View the classification, age restrictions and types of Dragonheart's twelve crews below and then tell us your preferences.
- Fire
- Green Mountain Girls
- Blazing Comets
- Youth/Student
- Dragonflyers
- Fifty Force
- Quicksilver
- Senior D (Name TBD)
- Sisters
- Soul Sisters
- Green Mountain Men
- Catch 22
Volunteerism
Dragonheart Vermont is a non-profit organization. Volunteers keep our organization running smoothly and aid us in accomplishing our mission. In addition to team volunteerism at community and fundraising events, we ask members to help in various areas of the organization. Expectations include sharing the Dragonheart Vermont mission through participation in DHVT community events including Practice Weekend and the Lake Champlain Dragon Boat Festival.
Volunteerism is part of being a Dragonheart Member(Required)
I will volunteer for Practice Weekend (PW) (July 15-16, 2023)
I will volunteer for the Lake Champlain Dragon Boat Festival (LCBDF)(August 6, 2023)
- I agree to volunteer for PW and the LCDBF (prep, planning or day of)
- I agree to volunteer for DHVT fundraising efforts
Please select where you have an interest in helping our organization(Required)
- Accounting/Finance
- Boat repair and maintenance
- Fundraising
- Event Planning
- Photography/Videography
- Social Media/Marketing
- Website Design/Maintenance
- Other
Please describe your other area of interest in helping DHVT.
Corporate sponsorships help sustain our organization!
We would like to approach your employer or acquaintance in the hopes of obtaining sponsorship on your behalf.

Provide more than one (up to four) by clicking the + sign at the right.
Company Name Name Email
Liability
Click here to read the Dragonheart Vermont Release of Liability.
Consent(Required)
I have read, understood, and agree to the Dragonheart Vermont Release of Liability
Liability for Youth Paddlers
If paddler is under 18 years of age, a parent or guardian must agree to the Release of Liability. Please enter the name of the parent or guardian completing this form below.
Current Age of Paddler(Required)
- Under 18
- 18 or older
Name of Parent/Legal Guardian
Click here to read the Dragonheart Vermont Release of Liability.
Consent(Required)
I have read, understood, and agree to the Dragonheart Vermont Release of Liability
COVID-19 Guidelines
In an effort to protect fellow members and their communities, please note that we follow current COVID safety protocols. Members who experience COVID-like symptoms should not attend practice(s) or DHVT gatherings and events.
A few more things...
Payment: Dues are paid via credit card. Installment plans are available for memberships costing $100 or more. More information is available at the end of this document. Note: You must be an enrolled member to participate in 2023 Off Season Training sessions and our water programs. We anticipate our first water practice will occur the last week in May 2023, weather permitting.
Upload Your Photo Here
Give us your best selfie from the shoulders up! Your picture will be available for viewing by other Dragonheart Vermont members on our members only web site.
Max. file size: 20 MB.
Membership Benefits and Pledge
Membership Benefits:
PADDLERS
~ Regularly scheduled water practices and workshops (in season)
~ Team and individual dragon boat coaching
~ Team building
~ Use of boats, paddles and butt pads (in season)
~ Eligibility to participate in dragon boat festivals / races (may have additional costs)
~ Improved endurance and fitness
~ Fundraising opportunities to offset race expenses
~ Improved endurance and fitness
~ Access to Off Season Training (OST) program and other wellness sessions sponsored by DHVT (additional cost)
~ Community involvement and awareness
~ Access to discounts at local retailers and service providers

NON-PADDLERS
~ Access to Off Season Training (OST) program and other wellness sessions sponsored by DHVT (additional cost)
~ Community involvement and awareness
~ Access to discounts at local retailers and service providers
As a Dragonheart Member, I pledge to:
~ Follow the mission of strengthening and empowering breast cancer survivors & supporters throughout the challenging sport of dragon boating.
~ Instill the organization’s core values of teamwork, fitness and community giving.
~ Attend membership meetings and practices regularly.
~ Volunteer at DHVT fundraising and community events.
~ Help the organization maintain the positive energy throughout the membership and community.
Agree to the Member's Pledge
I agree to the Dragonheart Member's Pledge

Save and Continue Later

Emergency Medical Information
Your medical information is made available only to the head coach, your coach, and emergency attendants in case of an emergency.
Doctor's Name/Practice
Doctor's Phone Number
Year of Last / Status of Tetanus Shot (enter as YYYY or 0000 if n/a or date unknown)(Required)
Year of Last / Status of Wellness Exam (enter as YYYY or 0000 if n/a or date unknown)(Required)
Emergency Contact(Required)
Relationship to Member(Required)
Contact's Cell Phone(Required)
Contact's Alternate Phone (Home/Work)
Insurance Information
Health insurance is not a requirement for participation
Insurance Company
Subscriber's Name
Relationship to Subscriber
Group Number
Policy Number
Medical Information
Please provide medical information that you think is important for us to know in order to assist you in a medical emergency.
List of Current Medications
Allergies
Please list any other medical information that you feel is pertinent to medical personnel in time of an emergency.
Dragonboat paddling is a water activity.
- I can swim
- I am CPR certified
Payment and Next Steps

After you submit this form, you will be directed to our payment page. If your membership status entitles you to a free membership, just close out of the payment page after that re-direct. Otherwise...

Optional payment plans are available for any membership type costing $100 or more for the year. These options require equal portions to be paid now and automatically billed to your credit card on today's date each month through May (or December for the year long monthly payment plan). See below for details.

Payment Options for Paddlers:
1. Pay in full now
2. Pay monthly ($22.00 each) for the entire year (only available to individuals who complete their application in January).
3. Pay in 4 monthly ($65.00 each) payments (available to individuals who complete their application in January or February).
4. Pay in 3 monthly ($86.50 each) payments (available to individuals who complete their application in March).
5. Pay in 2 monthly ($129.50 each) payments (available to individuals who complete their application in April).

Payment Options for Associate Paddlers, Non-Paddlers and Senior D Paddlers:
1. Pay in full now
2. Pay in two equal installments this month and next month. $52 per month for Non-Paddlers and Senior D Paddlers, $65 per month for Associate Paddlers.

You should receive an email with a copy of this form and a transaction receipt (be sure to check your junk mail if you don't see them promptly).
Name
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Company Name	Name	Email

2023 Membership Application

Step 1 of 2

Personal Information

Annual Membership Dues

Crew Determination

Volunteerism

Liability

Liability for Youth Paddlers

COVID-19 Guidelines

A few more things...

Membership Benefits and Pledge

Emergency Medical Information

Insurance Information

Medical Information