Course Health Form

Please complete the form below by 4:00pm the Friday before attending the course:

Title*:Firstname*: Surname*: Email address*: Course Title:

Please select the course you are attending. This will make sure we have booked you onto the correct course and your details are given to the instuctor on the day.

Course Date:*Address:*Town/City:Post Code:*Date of Birth:*Mobile Number:*

This is to contact you on the day in case of changes or problems

Booking Name:

The Name of the person who booked your place/Group. Without this we can't guarentee your place.

Emergency Contacts

For use on the day, Incase of an Emergency. No contact will be made to them about the course.

Emergency Contact Name:*Mobile Number:*Other Number (Home/Work):*Relationship to you:*2nd Contact Name:*Mobile Number:*Other Number (Home/Work):*Relationship to you:*

Medical Conditions

If you would rather you can contact us at the shop to discuss these, all information will be confidential

Medical conditions:

Weight Range

This is so we can put you in the correct Size Craft.:

Under 41kgs (6.5stone)

41kgs to 91kgs (6.5stone to 14stone)

68kgs to 110kgs (10stone to 17st)

Over 110kgs (17stone)

Booking Conditions

All participants must be in good health and be able to swim at least 100 metres un-aided. If weather conditions or other unforseen circumstances prevent us from running the course we reserve the right to cancel or re-book participants at our discretion. Refunds on cancellations will only be given if they are received in writing or email at least seven days prior to the date of the course.

All watersports are inherently dangerous and while all reasonable measures will be taken by us in order to keep you safe we cannot guarantee your safety on the course.

I agree to all above terms and conditions and have read and understood this form:

Participant

Parent/Carer (if under 18)

Do you intend to Park on site?:

Yes

If yes, please fill in vehicle registration number: