PPCC Summer Course Application Form 2018
Paddler Forename *
Your answer
Paddler Surname *
Your answer
Gender
Date of Birth *
MM
/
DD
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YYYY
PLEASE SELECT BELOW THE SESSION(S) THAT YOU WOULD LIKE TO BOOK
FULL DAY £130 HALF DAY £75
JULY 2 - JULY 6
JULY 9 - JULY 13
JULY 16 - JULY 20
JULY 23 - JULY 27
JULY 30 - AUGUST 3
AUGUST 6 - AUGUST 10
Next of Kin *
Your answer
Relationship *
Your answer
Email *
Your answer
Address *
Your answer
Emergency Contact *
Please provide full name, address and contact.
Your answer
Medical / Injury Details: *
Please detail any medical conditions/allergies that we should be aware of.
Your answer
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 *
Your answer
Date and Time
MM
/
DD
/
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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