Online Booking Form

UKSB03-213 Buccaneer weekend 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:

Course Details

Course / Voyage Number:*

Please confirm the course you wish to book.

Your Previous Expereince

Have you been on a sailing course before:*

If yes - please give details of certificates held:

Have you dived before ?:*

Needed for Dive Camps modules

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:*

How would you like to pay?:*

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:

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

Online Booking Form

UKSB03-213 Buccaneer weekend booking form

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