CLYC 2018 Course Registration

CLYC Powerboat Course Registration
Participant Information
Last Name *
First Name *
Middle Name
Gender *

Male Female
Address *
City *
County *
Postcode *
Birth Date (if under 18, min. age 16 years)

Month Day Year
Please select a course *

Powerboat Level 2 (Member) £150 Powerboat Level 2 (Non-member) £170
Previous Experience/RYA qualifications obtained
Please indicate below days of the week that do or do not suit
Parent or Legal Guardian Information (If under 18)
Parent/Legal Guardian *
Relation *
Work Phone *

Area Code Phone Number
Mobile

Area Code Phone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable) *
Emergency Number *

Area Code Phone Number
Email Confirmation
Contact Email (confirmation will be sent by email) *
Health Information
Date of last tetanus shot
Any activity the participant should be restricted from?
Any physical, mental or other condition that would require special attention or medication while on the course?
List all medications that might be needed on the day, e.g. inhalers.
List any allergies (ex: bees,peanuts, dairy)
Data Protection
Data Protection Act 1998. The above information including the questions as to your health and ability will be used by us to process your booking for the course and for attending to your safety whilst you are on one of our courses. If you would like to be added to our mailing list in order to receive details of future courses and events please tick below. You may opt out of receiving such details from us at any time by emailing: info@clyc.info. The data will not be shared with any third party for marketing or commercial purposes without first obtaining your explicit consent.

I agree to being added to the CLYC mailing list I agree to name and address details being shared with RYA for the purposes of issuing certificates I agree that photos of my child can be taken and used for club media purposes
Data Privacy. Our Data Privacy Policy can be found at www.clyc.info/privacy-policy/. The above information including the questions as to your health and ability will be used by us to process your booking for the course and for attending to your safety whilst you are on one of our courses. On successful completion of your course your name, certificate number and date of issue will be stored for up to 6 years allowing us to verify or replace your certificate if required. If you would like to be added to our mailing list in order to receive details of future courses and events please tick below. You may opt out of receiving such details from us at any time by emailing: info@clyc.info. The data will not be shared with any third party for marketing or commercial purposes without first obtaining your explicit consent.

I agree to being added to the CLYC mailing list I agree to name and address details being shared with RYA for the purposes of issuing certificates I agree that photos can be taken and used for club media purposes
Cancellation Policy
Please be advised refunds will not be considered for cancellations made 7 days or less from the start of the course.
Payment
Please check your email address is correct as correspondence will be by email only.

Completion of this form will put your name on a waiting list. The instructor will then contact you to arrange suitable dates. Once dates are confirmed course fees become payable. Course Fees are payable via Paypal (std Paypal charges apply). An email will be sent from paypal.
Please Indicate Payment Method: *

Paypal
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named sailor, and are over the age of 18. In the event of an emergency situation you give consent for medical teatment for the aboved named sailor by authorized personnel. You certify that your child has permission to attend the course and participate in all activites.
Electronic signature, please initials *
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

CLYC Powerboat Course Registration

Participant Information

Parent or Legal Guardian Information (If under 18)

Emergency Contact Info

Email Confirmation

Health Information

Data Protection

Cancellation Policy

Payment