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RYA NI Open Training

Helm First Name

Helm Last Name

Helm Date of Birth

Club

Helm Gender *

Male

Female

Other

Crew First Name

Crew Last Name

Crew Date of Birth

Crew Gender

Male

Female

Other

Sailing Competence

Emergency Contact Name

Relationship to Individual

Emergency Contact Number

Emergency Contact Email

Sailor Medial Information - Please select any that apply

Asthma/bronchitis?

Heart Conditions?

Fits, fainting or blackouts

Severe Headaches?

Diabetes?

Travel sickness?

Food allergies?

Any other allergies?

Any other illnesses or disabilities?

Are you currently taking madication?

Are you recovering from any injuries which may affect your involvement in the event?

Any Crew Medical Information we should be aware of?

If you have selected any of the above please provide details

PHOTOGRAPHIC IMAGES - Do you grant the RYA NI the absolute right to use the images resulting from photography at the activity mentioned above. This includes any reproductions or adaptations of the images for all general publicity purposes. *

YES

NO

DECLARATION - By registering for this training you confirm that you have read and understand:Parent - Guardian Declaration Form

Thanks for registering. See you there!

GE8 Sketrick House

Jubilee Rd

Newtownards

BT23 4YH

Company Number:

NI051945

ryani@rya.org.uk

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