Please Note Boxes with Blue Star's Must Be Filled In For The Booking To Be Accepted. When applying for multiple people on the same course, fill one form send it then use the browser back button and the form is still filled out change relevant information for the second person and then send. When finished then proceed to payment page to complete the booking. A confirmation of booking with all the data submitted will be returned directly and payment for the booking online confirms. Please Look At The Kit List Requirements, wetsuits are provided (if needed) by the centre, footwear must be provided by the candidate

Name Parent  Today's Date E-mail Address *

Address 1    Address 2       Address 3

Address 4 Postcode Telephone   Mobile

 Date Of Booking Required     Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31       Month January February March April May June July August September October November December    Year 2006 2007 2008 2009 2010 Time Of Booking       End Time 0800 08.30 09.00 09.30 10.00 10.30 11.00 11.30 12.00 12.30 13.00 13.30 14.00 14.30 15.00 15.30 16.00 16.30 17.00 17.30 18.00 18.30 19.00 19.30 20.00 20.30 21.00 21.30 Start Time 0800 08.30 09.00 09.30 10.00 10.30 11.00 11.30 12.00 12.30 13.00 13.30 14.00 14.30 15.00 15.30 16.00 16.30 17.00 17.30 18.00 18.30 19.00 19.30 20.00 20.30 21.00 21.30

Name            Date Of Birth Male    Female  

Adventure Zone Session    Activities RYA Powerboat Course Sailing Introductory Sailing Stage One Sailing Stage Two RYA Stage Three Windsurfing Starter Paddle Power Canoe & Kayak Paddle Power Passport Adventure Day Archery Extreme Water Day Camp Week * Swimming Ability Low (below 10mtrs) Medium 10-25mts 25mts+

No bookings will be taken unless full disclosure of medical conditions are made, ie Asthma, Epilepsy,

Heart Conditions etc. Please place it the box below if no conditions please place None

 Doctors Name   Doctors Telephone Number

* (Person Booking Name) Cost Of Activity

 Are you happy for photographs of your children to be used for promoting future

Adventure Zone programmes. Yes No

I Have Read The Conditions of Booking

and give consent to my young person participating In the activity I certify that they are fit for the activity and is water confident. I am aware that there are risks of injury associated with any activity and give my consent to any treatment in an emergency.

  *Please note*** Personal accident and loss/damage of belongings are not insured. Participants are covered by the venues insurance in the event of the providers negligence.

For Admin Use Only