Student Enrolment Form Page 2

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Student Enrolment Form
Frankston Yacht Club Discover Sailing Centre
COURSES
Better
Discover Sailing
Discover
Sailing
1&2
Racing
(Saturday
(
morning)
Sunday Morning)
(Friday afternoon)
APPLICANT DETAILS
First Name
________________________________
Last Name
___________________________________
Date of Birth ________________________________
Gender
Male
Female
Have you sailed before?
Yes
No
Where
___________________________________
Are you a member of a club?
Yes
No
YA Number
___________________________________
Can you swim 50 meters?
Yes
No
APPLICANT CONTACT DETAILS
Address
_______________________________________________________________________________________
Suburb
________________________________
State
____________ Postcode ______________
Telephone
________________________________
Mobile
___________________________________
Email
___________________________________________________________________________
GUARDIAN/NEXT OF KIN CONTACT DETAILS
Name
________________________________
Relationship
___________________________________
Telephone
________________________________
Mobile
___________________________________
Email
_______________________________________________________________________________________
MEDICAL
Do you or your child suffer from any illness or disability?
Yes
No
If yes, please provide details _________________________________________________________________________
Do you or your child suffer from any allergy or is allergic to any medication?
Yes
No
If yes, please provide details _________________________________________________________________________
In case of an emergency please contact the following person:
Name
________________________________
Relationship ___________________________________
Telephone
________________________________
Mobile
___________________________________
In case of an emergency, do you authorise the Learn2Sail Training Co –coordinator to arrange any necessary medical
treatment where prior notification has not been possible?
Yes
No
PHOTOGRAPHY CONSENT:
As part of the Learn2Sail program, photographs may be taken for promotional use within the club or related organisations.
I ……………………………… give consent for photographs to be taken of myself/my child during the Learn2Sail Program.
SIGNATURE
I hereby confirm that information provided here is true and correct
Signed __________________________________________________________________ Date _______________________
LIFEJACKET SIZE INFORMATION Do you need a lifejacket? If yes, please indicate what size
Yes
No
CHILDREN
XS 10-15kg
S-M 12-25kg
L 22-40kg
ADULT
S-M 40-60kg
L-XL 60+kg
XXL 60+kg
XXXL 60+kg
XXXXL 60+kg
PAYMENT
Please email complete application to Meaghan Densley, Sail Training- Email
Please find enclosed my cheque (made payable to Frankston Yacht Club) for $_____________
Or
Please find enclosed my cash for
$_____________
Or
Direct Payment can be made to 063133 00222700 Please identify your name with payment. $_____________
TRAINING OFFICE USE
Payment amount: ________________ Date Received: ________________ Date Approved: ________________

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