Name of Course (required)
Date From (required)
Date To (required)
Name of Student (required)
Date of Birth (required) dd/mm/yy
Address (required)
Postcode (required)
Telephone No (required)
Mobile No
Your Email (required)
Health (required) I declare to the best of my knowledge, I am fit to participate in the course applied for. I will inform Mendez Marine of any Heart condition, Dizzy spells, Epilepsy, Diabetes or other condition before attendance on the course. If none enter 'none'.
Suffering from any of the above will not preclude you from any activity, but will assist the instructor on the course of action to take in the event of an emergency.
I can swim 50 metres: ConfidentlyModeratelyWeakNot at all
Dietary requirements Please note we can only cater basic requirements such as vegetarian or food allergies please call the office if in doubt.
Emergency Shoreside Contact Name (required)
Emergency Shoreside Contact Telephone No
Emergency Shoreside Contact Mobile No (required)
I agree to theTerms and Conditions.
