Order Number
Course Start Date
Participant First Name (Change if different from
Participant Last Name
Next of Kin Last Name
Next of Kin Contact Number
Relationship to you (the Participant)
Do you have any medical conditions or allergies we should be made aware of? NoYes
The course you intend to undertake may require a certain level of physical activity. If you have any concerns about your ability to take part in the course due to health or fitness reasons you should consult with your doctor. If you believe you may require special assistance or some form of reasonable adjustment to be able to take part in the course, please contact us to discuss your requirements. Having an existing medical condition or special requirement will not automatically prevent you taking part in a course. ? NoYes
Terms & Conditions *By ticking this box, I declare that I have read the terms & conditions and agree to be bound by them, and that I am physically fit to take part in the activities provided.
