Your Details

First Name*

By which you would like to be known on board

Last Name*

Title*

Start date of the course you have booked*

Which course are you completing?*

House No. & Street Name*

Address Line 2

Town*

County*

Postcode*

Email*

Mobile Phone No.*

Gender*

Male
Female

Date of Birth*

Next of Kin Name*

Shore-based contact

Next of Kin Address*

Next of Kin Phone Number*

Dietary Requirements*

Anything (within reason)
Vegetarian
Vegan
Allergy Requirement (please specify)
Other (please specify)

Dietary Requirements Detail

Foul Weather Clothing Size*

Mens: Small | Womens: 10/12
Mens: Medium | Womens: 12/14
Mens: Large | Womens: 16
Mens: Extra Large | Womens: 18/20
Not Required - I will bring my own.

Health Declaration*

I declare that to the best of my knowledge I am not suffering from any medical condition, such as Angina, Asthma, Epilepsy, Giddy Spells, or any Heart Condition. Advice should be sought from your GP if you have any concerns. The listed conditions do not preclude you from taking part, but we must have all the relevant details. These will be treated with the strictest confidence.

Agree
Disagree - Listed Health Condition

Health Condition Detail

Previous RYA Qualifications?

Previous Sailing Experience?

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