PPCC Summer Course Application Form 2019
Paddler Forename *
Paddler Surname *
Gender
Clear selection
Date of Birth *
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PLEASE SELECT BELOW THE SESSION(S) THAT YOU WOULD LIKE TO BOOK
FULL DAY £140 HALF DAY £80
JULY 1 - JULY 5
Clear selection
JULY 8 - JULY 12
Clear selection
JULY 15- JULY 19
Clear selection
JULY 22 - JULY 26
Clear selection
JULY 29 - AUGUST 2
Clear selection
AUGUST 5 - AUGUST 9
Clear selection
Next of Kin *
Relationship *
Email *
Address *
Emergency Contact *
Please provide full name, address and contact.
Medical / Injury Details: *
Please detail any medical conditions/allergies that we should be aware of.
By signing below you confirm that:
a) You agree to the above named child taking part in water sport activity sessions delivered by Pinkston Panthers.
b) You agree to above child receiving medication or medical aid in the event of an injury.
c) Your child is able to swim 50 metres unaided.
d) You have made us aware of any relevant medical conditions prior to the course start date.
Signature *
Date and Time
MM
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DD
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YYYY
After completing the form we will then confirm availability for you chosen course. Following this you will be required to pay via Bank Transfer. A place will only be booked after payment is made. If you have any questions or queries please don't hesitate to contact us at pantherssummer@gmail.com
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