course joining form COURSE REGISTRATION & MEDICAL FORM Course Name Adult Start Sailing Spring Course L 1+2Youth Start Sailing Spring Course S 1+2Adult Start Sailing Autumn Course L 1+2Youth Start Sailing Autumn Course S 1+2Adult Start Sailing Autumn Course L 3Youth Start Sailing Autumn Course S 3Youth Start Sailing Autumn Course S 4Level 2 Power BoatSafety BoatStart RacingSailing with SpininakersSeamanship SkillsFirst AidVHF Marine Radio (SRC)Navigation Theory CourseSea Cadet RYA coursesDI CoursePBI CourseOther - please specify below Start date Student's Personal Details Your Name (required) Date of Birth (required) Your Home address (required) Your Email (required) Phone Numbers Emergency Contact Personal Details Next of KinParent or Guardian (required) Emergency Contact Address Your Doctor's Name (required) Your Doctor's Phone Number Medical declaration It is your responsibility to make known any potential medical conditions that may affect you during the activities associated with the training programme or event you are taking part in. This information will be only shared with the organisers and coaches at training and events. For example asthma, heart conditions, epilepsy etc. Please provide details in the box below When did you last have a Tetanus immunisation Equipment I understand that I will have to provide my own clothing, waterproofs and footwear for the course. The Training Centre will provide boats and buoyancy aids free of charge for the duration of the course. The Training centre will provide tea, coffee, juice and biscuits throughout the day but please bring your own packed lunch each day. There is a microwave and stove available for your use. I give permission to the organisers and coaches of activities during the training period or event to administer any relevant treatment or medication to the above named participant when or if necessary. Parental Consent: In an emergency situation I authorise the organisers and coaches to take my son/daughter to hospital and give my full permission for any treatment required to be carried out in accordance with the hospital’s diagnosis. I understand that I shall be notified, as soon as possible, of the hospital visit and any treatment given by the hospital. Please tell us anything else that you think is relevant. I can swim 50 metres without a buoyancy aid? I consider that I am fit enough to undertake the above course and agree to the above Course Fees I have sent a chequeI have sent payment by EBanking Payment amount £ Payment date Electronic Banking: Nantwich & Border Counties Sailing Club, Barclays Bank Plc, Newcastle -under-Lyme. Sort Code 20-59-23 Account No. 30661333 Quote your name under “reference” Cheques are payalbe to N & B C S C please Please click Send