Please enter as much information as possible: Name Date of Birth Course [please choose] RYA Powerboat Level 1 RYA Powerboat Level 2 RYA Powerboat Advanced RYA Powerboat Intermediate RYA Smallcraft First Aid RYA Sea Survival RYA VHF/DSC radio RYA Yachtmaster Offshore Theory RYA Dayskipper Theory RYA Essential Navigation (Basic) Course Date Address #1 Address #2 Town County Post Code Telephone Number Email Next of Kin Relationship Contact Number Do you suffer, or have you ever suffered from any of the following? Asthma or Bronchitis Heart Condition Fits, Fainting or Blackouts Severe frequent headaches Diabetes Allergies to known drugs Seasickness Any Sensory Impairment Other Illness or Disability If you have ticked any of the above, please give full details in the following box,and be sure to make your instructor aware on the day. Details In submitting this form, I declare that I am physically fit to take part in watersports activities and that I am confident in the water. (Able to swim 25m in light clothing.)I agree to abide by the rules and instructions given to me by the staff of Seawake Powerboat Training.