Provela Academy booking Form All participants of Provela Academy courses and activities are required to provide next of kin contact details and a medical declaration, prior to starting their course. In the case of under 18’s, forms should be signed by a parent or guardian. Course Details: Course Title RYA Powerboat Level 1RYA Powerboat Level 2Private Powerboat TuitionRYA Dinghy Adult Level 1RYA Dinghy Adult Level 2RYA Dinghy Adult Level 3RYA Dinghy Youth Stage 1RYA Dinghy Youth Stage 2RYA Dinghy Youth Stage 3RYA Dinghy Youth Stage 4RYA Seamanship SkillRYA Day SailingRYA Sailing With SpinnakersPrivate Sailing TuitionStand Up Paddleboard Hire Start Date Finish Date Participant Details: Title MrMrsMsMissDrMx First Name Surname Email Contact Number Date of Birth Postcode Address Next of Kin Details:Name Relationship to Participant Emergency Contact Number Medical Details: Please answer the following questions but be assured that answering “Yes” will not necessarily prevent you from taking a full part in your chosen course. Do you suffer from any of the following conditions? Epilepsy, Giddy spells, Asthma, Diabetes, Angina, or other heart condition? Back or neck problems Are you currently taking any medication? Do you have any disability or concerns relating to your health during this course? Can you swim more than 50m unaided? Do you have any current medical condition not shown above? If so, please state below. Confirm:MEDICAL DECLARATION I declare that the responses I have provided above are correct to the best of my knowledge and I know no reason related to my health and well-being that will prevent me from undertaking this course. I will inform the Instructor immediately should I have any difficulties during the course. PHOTOGRAPHY CONSENT I give consent for any photographs taken to be used for future marketing. TERMS AND CONDITIONS & PRIVACY POLICY I have read and agree to the Provela’s Terms and Conditions. I also consent to the above details being used to contact me. For RYA courses names and addresses of candidates will be shared with the RYA for the purposes of registering your certificate. For full details please visit our website. Submit Booking Form