DOVER SEA SCHOOL - RYA Practical & Theory Training Course application form

DOVER SEA SCHOOL APPLICATION FORM
e-mail - mailto:michael.oram@btinternet.com
Telephone / Fax+44(0)1843 852858 -
.

Course required_______________________________ -- Practical / Theory Course
Date/s required _______________________________
Name __________________________________ Date of birth __day___month____year
Address ________________________________ Nationality _________________
_______________________________________ Passport No _______________
Post Code _____________________ Tele/Fax____________mobile _____________

Group members: (name & address)
1. _____________________________________ Date of Birth __ day__ month___ year
_______________________________________ Tel/Fax _____________
Post code _________ Counrty_______________ Passport No _________
2. _____________________________________ Date of birth __ day__ month___ year
_______________________________________ Tel/Fax _____________
Post code _________ Country _______________ Passport No _________
3. _____________________________________ Date of Birth __ day__ month___ year
_______________________________________ Tel/Fax _____________
Post code _________ Country _______________ Passport No _________

Payment
Single/Group leader. Course fee(_____days).	£______.____
Group members (_______) Course fee.	£______.____
Accommodation / books / etc.	£______.____
Extras	£______.____ £______.____
TOTAL -- less VAT	£______.____
VAT 17.5%	£______.____
TOTAL including VAT	£______.___
Deposit -- (£100.00 + VAT = £117.50 per person minimum)	£______.____
Balance due	£______.___
Balance Paid -- on (date ___/___/___/)	£______.____

CREDIT CARD PAYMENT
I wish to pay by Barclaycard/Visa ~ Mastercard/Access - Switch - Delta.
Name on card _______________________________ Card Type ___________
My card number is :___________________________ Expiry date ____:_____
Total amount £_____:____
Signature _____________________ date: __ day__ month ___ year

Bookings can be made by e-mail - fax - post or telephone
alternative e-mail address michael.oram@btinternet.com
(Please post original completed form to 12 Vale Square, Ramsgate, Kent CT11 9BX)

DOVER SEA SCHOOL APPLICATION FORM - Page 2

Please read the notes & information sheets on this web site before filling in this booking contract.

Your answers to these questions are for safety and do not affect your attending the course

I/We can swim 50 metres in light clothing

YES / NO

SPECIAL REQUIREMENTS - Is any member of the group suffering from

Epilepsy, Disability, Giddy Spells, Asthma, Diabetes, Angina, or Heart Conditions.	YES / NO
Or any special health considerations	YES / NO
Or needs for Special Medication	YES / NO
Or requires a special Diet (please specify)	YES / NO
Are there any special requests or details for our attentions?	YES / NO

ADDITIONAL NOTES_________________________________________________ _____________________________________________________________________ _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Emergency contacts ashore during the course:
Name: ______________________________ Tel no's. _______________
Name: ______________________________ Tel no's. _______________
Name: ______________________________ Tel no's. _______________

I/we are fit to participate in the course activities and I/We are willing to comply with all safety regulations and conditions of booking. I/we have read the terms and conditions attached. My/our signature on the booking form implies acceptance of these terms and conditions. The person so signing has the authority of the other persons included on this booking form to accept the terms and conditions and to make the booking on their behalf.
Signature/s _____________________________________ Date _____________

TERMS AND CONDITIONS
1. We reserve the right to modify or cancel any course at our discretion and we shall not be liable for any loss, damage, delay or inconvenience resulting there from. Any cancellation by us due to circumstances beyond our control will limit our liability to the return of the fees and /or deposits already paid to the school or their transfer to an alternative booking.
2. The school reserves the right to retain deposits and fees paid in the event of the clients cancellation at any time prior to the start of the course. Any refunds made will be at the discretion of the school after expenses are deducted.
INSURANCE The school craft are insured for accident & third party liability. No responsibility is accepted in any circumstances for the personal effects or the illness or delays of the clients / pupils. The clients / pupils agree to indemnify the school and its instructors and staff against any liability claim whatsoever.
Personal travel insurance and a P111 form are recommended. P111 health forms are avalible from your local post office and explain the national health agreements with other countries. They must be completed before departure.