Book a Course

Quaystage Training Course Booking Form

Please fill in your details below and we will contact you as soon as possible.

Enter not this field:

Personal Information

Full Name:*

Full Address:*

Your Age:
	Remember you must be at least 14 by the time you start the course

Your email:*

Contact Telephone number:*

Daytime contact no (if different):

About you

Date of Birth Details:*
	DD/MM/YY

Place of Birth:

Nationality:

Passport Number:

Which Course

RYA Practical:
RYA Shorebased:
Quaystage Adventures:
PADI Dive Courses:
Quaystage Career Development Courses:

Course Details

Course / Voyage Number:
	Enter if known

Course Dates:
	If known

Assistance Required:
	Would you like help to find the correct course for you?

Your Previous Expereince

Have you been on a sailing course before:*
If yes - please give details of certificates held:
Have you dived before ?:*
If yes - please give details of certificates held:

Next of Kin

Next of Kin:
	Who will not be on board with you

Their address (if different to above):

Their contact telephone number:*

Relationship:

Medical and Dietary Requirements

I will complete my medical form:*
	We require you to complete a medical and dietary form.

Secure your Place

How would you like to secure your place:*

Pay by Card:*
	You can pay over phone or via an Online form

How did you find us?

How do you hear about us?:
Where you referred by Quaystage staff?:
If yes - please give staff name:

Parent / Guardian consent for under 18's

I confirm that I am the parent / Guardian of the above applicant and I am willing for him to attend this course:
	Please enter your full name

Are you the principle contact:

Principal Contact's details:

*Indicates a field you must enter.

When you have completed the form, please click the Send Details button ONCE to send