Powerboat Booking Form

Full Name *

Title *

Gender *

Date of Birth: Day *

Month *

Year *

Address *

Address Extra Info

Town *

Post Code *

Country *

Email address *

Phone Number *

Tax number for invoice (if required)

Details for invoice (if different from above)

Course Attending *

Start Date *

Can you swim 50 meters? *

MEDICAL CONDITIONS Details of any medical treatment being received - if none please write ‘None’ *

By signing and dating this form, I declare that to the best of my knowledge I am not suffering from epilepsy, disability, giddy spells, asthma, diabetes, angina, or other heart condition nor have I suffered any back injury and I am fit to participate in the course - None of the preceding in any way excludes you from course participation.

Emergency Contact Name *

Emergency Contact Phone Number *

Do you consent to us using any photo´s and videos made during the course to use for our promotions (social media/website etc)? *

rusailing and its employees do not accept responsibility for any loss, damage or injury suffered by persons and/or their property arising out of or during the course of their activities whilst sailing, training and/or coaching and/or instructing unless such injury loss or damage was caused by, or resulted from negligence or deliberate act.

I have read rusailing’s terms and conditions on their web site, agree that my booking is subject to those conditions and have arranged adequate travel, health and cancellation insurance. All information I have given is correct *

I agree

Date

Nautical School

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