BOOKING/APPLICATION 
Name: Mr/Mrs/Ms/ :- ________________________________________________ Ref. 07.________
Address.
___________________________________ ____________________________________
___________________________________________
____________________________________
gTel. H
____________________ W____________________ Mob.________________________
F._______________ e-mail_____________________________ Date of
Birth _______________
Passport No.___________Family/Shore
contact:- ___________________Tel._________________
________________________________________________________________________________
Course
required:- _____________
Preferred date(s) _______Code ____ Second Pref.
_______Code _____
·
Are You currently in
receipt of Medication or do you suffer
from a condition that the Instructor
should be
informed about? If so, in the interests of your own and the other participants
safety, please
let
us know below. (Doctors Certificate might be required).
Medical
details __________________________________________________
_________________________
I confirm
that I (my child/ward) am/(is)
fit to take part in a Sailing Course/Holiday and I
agree
to the Terms and Conditions of SOUTH EAST CRUISING SCHOOL.
- N.B. - Signed:- _________________________________ Date:-___________
For
Course Participants U-18, Permission of Parent/Guardian is required below.
I
confirm that (name)________________________has my
authority to participate in Courses run by SOUTH EAST CRUISING SCHOOL
- Signature of Parent/Guardian________________________ Date:-_________
Please read
and complete/delete where appropriate, below
·
It is strongly recommended that you
take out Personal Accident Insurance for the full duration
of
your Sailing Course, as sailing is an outdoor activity with an inherent risk of
possible injury, which
could
involve loss of earnings.
·
I will
/ will not require Oilskins (size XL / L / M / S ) (Y/N) @ €15.00 per set
·
*Boots
(size ___ ) (Y/N) / *Sleeping Bag (Y/N)
/ (*both supplied free)
·
I have special dietary needs Y / N Details
________________________________________
To secure
your booking, please forward €75.00 with
this form, with the balance due at least
28 days before
the start date of your Course. SOUTH
EAST CRUISING SCHOOL 's
boats are fully
insured against
accident and third party liability. Insurance for Personal Accident, Injury and/
or Loss
of Training is the responsibility of Course Participants.
Credit Cards
Accepted MC & Visa - No._ _ _ _ ¦ _
_ _ _ ¦ _ _ _ _ ¦ _ _ _ _ Expiry
Date _____
Name on Card___________________Signature
of Cardholder ____________________
Please cross
cheques and make payable to SOUTH EAST CRUISING SCHOOL
I heard of SOUTH EAST CRUISING SCHOOL from___________________________
BACK to SCHEDULE
Send to
South East Cruising School, 7
Glenvale Park, Wicklow –
00353 (0)404 69970 / (0)87 2394379
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