Full name:

Date of birth (dd/mm/yy)

Gender:

Male Female

Nationality:

Australia Austria Belgium Brazil Canada China Denmark Finland France Germany Gibraltar Greece Hong Kong Hungary Iceland India Ireland Italy Jamaica Japan Luxembourg Netherlands New Zealand Norway Poland Portugal Spain Sweden Switzerland United Kingdom United States

Address:
(Inc postcode)

Telephone:

Mobile:

Email:

Course:

Introduction to Sailing Competent Crew Day Skipper Coastal Skipper Yachtsmaster One Day Taster Weekend Introduction to Sailing 5 Day RYA Cert Course 7 Day RYA Cert Course Bespoke Course

Preferred date(s) - Week commencing:
List 3 options dd/mm/yy

Sailing experience:

Do you require waterproofs? (£10)

Yes:

No:

If 'Yes' select size:

Small Medium Large Extra large

Do you need an RYA logobook? (£5)

Yes:

No:

For safety reasons we need to know:

Your weight:

Your height:

Can you swim 100 metres?

Yes:

No:

Contact person - in case of an emergency:

Their telephone numbers:

Your relationship:

Health declaration:

You MUST inform us of any medication or medical treatment you are receiving.

I declare that to the best of my knowledge I am not suffering from any condition that may render me unfit to participate fully in the course. Please make sure your Instructor knows of any medical problems and/or disabilities you may have. This need not prevent you from sailing, however, please check with us before booking.
I accept the above declaration.