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Oliver Mason
Midland Sailing Club Course Sign-Up Form
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
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1920
1921
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2019
/
Month
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January
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/
Day
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For Buoyancy Aids (not required for RYA First Aid course)
Weight (kilograms)
Height (centimetres)
Emergency Contact Details
Please specify whom we should contact in case of emergency
Relationship to Emergency Contact
Partner
Parent
Other Relative
Friend
Other
Course
Please select which course you want to attend
RYA Level 1 (Start Sailing)
RYA Level 2/3 (Basic Skills/Better Sailing)
Seamanship Skills
Sailing with Spinnakers
Start Racing
MSC Crewing Course
Powerboat Level 1
Powerboat Level 2
Safety Boat
First Aid
RYA Youth Sailing Scheme
DI Race Endorsement
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")
Gift Voucher
Cash (to be handed to Principal at the beginning of the course)
Comments/Notes/etc
How did you hear about this course?
Submit