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Please print off and sign one copy per
participant.Please ensure that you
have read and fully understood our terms and conditions before signing
this form.
Please complete in block capitals, tick where appropriate, and send
with your Deposit
& Release Form
to:
ORCA, PO Box 111, Keswick, Cumbria. CA12 4YE.
Tel: 07974767602
Please note if you print this, it
is 4 pages long, you can always use the PDF
page (only 2 pages)
BOOKING FORM
| Full Name: |
Address:
Post Code: |
| Tel Home: |
Tel Work: |
| E.Mail: |
Tel Mobile: |
| Date of Birth: |
| Course Date: |
Course Title: |
I will arrive by car (or)
I will require transport from the nearest railway station |
| Please confirm how you will arrive, at least one
week prior to the commencement of your course. |
| Payment: |
Deposit of £100
per person per course:
Deposit of £250 per person for Sweden :
Full payment (if course starts within 4 weeks):
Optional £25 for one night in hotel at end of course
River Runner's + Voyager only:
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| Total: |
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| Please make cheques and postal orders payable
to Open River Canoe Adventures. |
| Declaration signed by the person named above:
I agree that I have read, and that I accept the 'Open River
Canoe Adventures' (ORCA) Terms & Conditions. I agree to
pay the balance outstanding no later than four weeks prior to
the course commencement. I also recognise and agree that, as
with any outdoor activity, the courses and events offered by
ORCA contain an element of personal risk, and that however unlikely,
the risk can become a reality. |
| Signed: |
Date: |
Current courses 2010
EMERGENCY DETAILS & RELEASE FORM
| In the event of a
serious injury whom should we contact on your behalf? |
| Title: |
First Name: |
Surname: |
| Tel No. Home |
Tel No. Work |
Mobile No:
|
E.mail: |
| How are they related to
you : |
| Your Medical / Dietary
Details. |
| Blood Type & Rhesus
Factor (if known):
N.H.S. No. (if known): |
| Have you had a Tetanus
booster within the last ten years? Yes / No |
Are you vegetarian
and do you suffer from any food allergies? E.g. Gluten, Nuts,
etc.
|
Do you suffer from
any medical conditions, allergies, or recent injuries that
we should be aware of? E.g. Asthma, Diabetes, Epilepsy, Haemophilia,
Arthritis, Hay Fever, Insect Stings, etc.
|
Are you currently taking
any prescribed medication? Yes / No
If yes, please list:
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(Optional) For the
well-being of our First aiders, we would be grateful if you
could mention any known blood diseases that you may suffer
from? E.g. H.I.V., Hepatitis B, etc.
|
| Can you swim 50 mts. ?
Yes / No |
Do you have any previous
experience of Canoeing? Yes / No
If yes, please give details:
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ALL INFORMATION WILL BE
TREATED IN THE STRICTEST CONFIDENCE.
Declaration signed by the person named above: I recognise and
agree that, as with any outdoor activity, the courses and events
offered by ORCA contain an element of personal risk, and that
however unlikely, the risk can become a reality. |
| Signed: |
Date: |
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