Booking Form

Name |
Surname |
Date of Birth |
Email |
Contact No |
Postal Address |
Post Code |
Country |

Where did you hear about us?

Course Information (please tick)

Powerboat Courses

 Powerboat Level 1 Powerboat Level 2 Powerboat Intermediate Powerboat Advanced Powerboat Instructor Powerboat Level 2 assessment
Shorebased Courses

 VHF Dayskipper YM Coastal/Offshore YM Ocean CEVNI
Motor Cruising

 Helmsman Dayskipper Coastal Skipper YM Offshore
PW (jet ski) Courses

 PW Proficiency PW Instructor
Others

 ICC up to 10m ICC over 10m Own Boat Tuition Other


Please specify the date(s) you would like to attend your course(s):

From     To


Own Boat Tuition Only:


Boat Name:
Berth Location:
Berth Number:

Medical Details

Please provide full details of person you wish to
be contacted in the case of an emergency:
Please state any illnesses/disabilities/medications
received below, e.g. epilepsy, giddy spells, diabetes,
angina or other heart conditions (if none please
state none):
Name |
Phone |
Address |
Email |

Agreement

I hereby confirm that I am physically and mentally fit and able to take part in the course(s) requested above. I have declared any medical conditions, ailments or medications received. I have read and agree to the terms and conditions detailed here and those detailed in the full terms and conditions of booking.
 Yes N/A
Please Note: Illness, disability or receipt of medication does not necessarily prevent participation in any course but for your well-being and safety we must be informed of all the relevant details prior to the course.


I hereby confirm I am the legal Gaurdian and agree to these terms on behalf of the minor completing this booking.  Yes N/A