Adult Learn to Sail Course: 17/18 March

Adult Learn to Sail Course on 17/18 March

Personal Details	Please note: All required fields are marked with an *
Name *	Date of Birth *	Sailing Club *
Invalid Input	Invalid Input	Invalid Input

Have you ever suffered from any of the following conditions:
Asthma / Bronchitus *	Yes No Invalid Input	Heart conditions *	Yes No Invalid Input
Fits, fainting or blackouts *	Yes No Invalid Input	Severe headaches *	Yes No Invalid Input
Diabetes *	Yes No Invalid Input	Travel sickness *	Yes No Invalid Input
Allergies to Medication *	Yes No Invalid Input	Any other allergies *	Yes No Invalid Input
Other illnesses or disabilities *	Yes No Invalid Input

If you have answered yes to any of the above, please provide details:	Invalid Input
If you are currently taking any medication, please specify:	Invalid Input
If you are suffering/recovering from any injuries which may affect your involvement with the programme, please specify:	Invalid Input
If you are vegetarian or have any food allergies, please specify:	Invalid Input