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(s) 1 2 3 4 5 6 Date Of Birth 1 2 3 4 5 6 Male 1 2 3 4 5 6 Female 1 2 3 4 5 6 Swim Ability 1 2 3 4 5 6
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 Tri Dives Snorkel Forest Skills
1 2 3 4 5 6
Doctors Name Doctors Telephone Number
No bookings will be taken unless full disclosure of medical conditions are made, ie Asthma, Epilepsy,
Heart Conditions etc.
* (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
Paid On Site Yes No
Paid
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