Wicklow Sailing Club

                    
     

Powerboat Training Course

                    
Booking Form                              
Name             Course:                  
Address                                  
              Date                    
Home Phone No.                              
Work Phone No.         Course Fee                  
Mobile Phone No.                              
Fax No.             Deposit                   
Email Address                                
              Cheques should be made payable to             
Date of Birth.           Wicklow Sailing Club.                
Club.                                  
1.  Do you have any disability or medical condition that may effect you on the                 
course.               Yes          No.                            
2. Are you taking any medication at present.         Yes.           No.                  
If you have answered yes to either of the questions above please give details below. (in confidence.)                
                             
If you suffer from any of the following Epilepsy, Asthma, Diabetes, Angina or any other heart condition, please consult your doctor before making a booking and be prepared to produce a note from him if requested.                
Please give contact details of the person to contact in case of emergency.            
Name.                                  
Address.                                
                                   
Phone Number.                                
In signing this form I confirm that I am physically fit to take part in this activity. I am confident in the water. I will comply with all safety procedures and instructions given by the course instructors.                          
Signed           Date.                      
  All courses are held subject to weather and sea conditions and the fulfillment of safety requirements. Wicklow Sailing              
   Club reserve the right to cancel any course for the following reasons. If the number of students has not reached              
    the minimum required number 6 days prior to the course date. For any reason of safety it would be unsafe to proceed.              
    THIS BOOKING FORM PLUS €100 NON-REFUNDABLE DEPOSIT MUST BE RETURNED 10 DAYS BEFORE THE COURSE DATE.             
       THE FINAL PAYMENT MUST BE MADE  BEFORE THE START OF THE COURSE.                
     IN THE EVENT OF THE COURSE BEING CANCELLED  ALL DEPOSITS WILL BE REFUNDED.