Online Entry

Training 2019

To reserve you place please complete the form below.
Please note that in completing this form Llyn Brenig Sailing club will hold your information. This will be used to communicate with you regarding the course and any events and promotions. Your information will not be shared with any third parties. This website uses tracking cookies to enhance the user experience. These cookies are only used to track movement and send you to the correct page on this website.
First Name
Date of Birth
Post Code

Emergency Contact Details

Contact Name
Relationship to Helm
Home Telephone
Work Telephone
Mobile Number
Doctors Name
Doctors Telephone

Medical Declaration

Have you suffered from any of the following

Asthma or Bronchitis

Heart Conditions

Fits/ Fainting or Blackouts

Severe Headaches


Travel Sickness

Allergies to medication

Any allergies

Other illness or disabilities

Please provide details

Date of last tetanus vaccination :

Please list any current medication here :

Please list any injuries that may be relevant to your participation in this event


I can confirm that I have read the course description. (If you are unsure please

contact the Training Principal before confirming your booking)

I confirm the participant is physically fit to undertake the course booked; that I

have reported any relevant medical problems and that I will notify you if any

circumstances change prior to arrival.

I agree to be bound by the rules and bylaws of Llyn Brenig Sailing Club as

published elsewhere on this web site.

During the event I will hold a valid and current 3rd party liability insurance of at

least £2 million pounds (if sailing my own boat).

I accept the above :