Midland Sailing Club Course Sign-Up Form

All the data collected through this form will only be used in the context of the training course run at Midland SC. This data will not be shared with third parties, and will be deleted when no longer required.

Full Name

Your E-Mail Address

Phone Number

Mobile Phone Number

Address

Date of birth

Year / Month / Day

For Buoyancy Aids

Weight (kilograms)

Height (centimetres)

Emergency Contact Details

Please specify whom we should contact in case of emergency

Relationship to Emergency Contact

Please indicate the date of the course you would like to take:

Medical Declaration

Sailing is a physical activity. It is your responsibility to inform us of any conditions that might affect your ability to take part in the course.

I feel comfortable in and around water (you will be wearing a buoyancy aid during the course)

To the best of my knowledge I do not suffer from epilepsy, giddy spells, asthma, diabetes, angina or other heart condition, or anything else that would affect my successful completion of the course

Please give details of any medical problems, allergies, and treatment being received (if applicable)

Fee and Payment Information

The fees for training courses are given on the club website; please consult this to work out the total amount due. For queries please ask training@midlandsailingclub.org.uk

Payment Methods

Bank transfer (acc 6063 1892, sort code 20-07-82, ref your surname plus course title)
Cheque (payable to "Midland Sailing Club")
Cash (to be handed to Principal at the beginning of the course)

Comments/Notes/etc

How did you hear about this course?