BRADWELL OUTDOOR EDUCATION CENTRE

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					 BOOKING FORM
 3rd Sudbury Scout Group RYA Training Centre




 Quay Lane
 Sudbury,




                                                                                                                   
 Suffolk, CO10 2AN
 Phone: 07980802213

 Email: robert.palmer10@virgin.net

 Course dates: ................……........….........Type of course: ......................…....................……………….

 Name in full : .................................................................. Date of Birth:.......................... Male/Female

 Address: .....................................................................................................................……………………

  …...............................................................………………… Postcode…………………………………….

 Contact phone no: ……………………..                           Email address ……………………………………………………..

 Is there any medical history/disability of which the Centre Staff should be aware eg: epilepsy, allergies, hearing

 difficulties, mobility, asthma etc: ..................................................………………………………………….

 Do you consider yourself to be:                        able / disabled / registered disabled              please 

 Ethnicity ……………………………………………………

 Catered courses: Do you have any specific dietary or allergy requirements? ………………………………

 Emergency contact phone no: 1) ................…………….. relationship …………….…………...
                            2) ………………………… relationship …………….……………

 Doctors Name: ………………………………………                                               Doctors Phone no: ……………………..
                                                                                                                  rd
 Please return this completed form together with a Cheque for £                               per place, to 3 Sudbury Scout Group,
 Sudbury, Suffolk, CO 10 2AN.
                                    rd
 Please make cheques payable to 3 Sudbury Sea Scouts.

  I confirm that I am confident in the water & can swim. I am also prepared to accept the guidance of the instructors
    rd
at 3 Sudbury Scout Group during the course.

   Signature of applicant: ...........................………………..........................                 Date: .........................................

 If the candidate is under 18 years of age:
                                                                                           rd
 I give consent for my son/daughter to take part in the agreed programme of activities at 3 Sudbury Scout Groups
Powerboat Training Centre.

 Signature of parent/guardian.............................................……………….……. Date: ………………………......

                                                            www.riverstour.com

				
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posted:11/5/2011
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