£0
First Name (required)
Middle Name
Surname (required)
Date of Birth (required)
Email (required)
Phone (required)
Participant Address:
Name of next of kin
They are my—Please choose an option—Spouse/PartnerParent/GuardianGrandparentAunt/UncleCousinSiblingChildFriendOther
Phone
Is their address the same as above? YesNo [group kinaddressdifferent clear_on_hide] Next of Kin Address: [/group]
Course Title—Please choose an option—RYA Powerboat Level 1RYA Powerboat Level 2RYA Intermediate PowerboatRYA Advanced Powerboat---RYA Personal Watercraft ProficiencyRYA Safety BoatRYA Powerboat Instructor---MCA Basic Safety Training STCW 95/ 2010Elementary First AidSTCW Personal Survival TechniquesPersonal Safety and Social ResponsibilitiesFire Prevention and Fire FightingProficiency in Designated Security Duties---RYA First AidRYA VHF/SRCRYA/MCA Sea SurvivalRYA/ISAF/World Sailing Offshore Safety---RYA Day Skipper TheoryRYA Coastal / Yachtmaster TheoryDEFRA Water Safety Level 1DEFRA Water Safety Level 2
Start Date
End Date
[group powerboat] Do you hold your Short Range Certificate? YesNo Do you hold RYA Dayskipper (Shorebased) Certificate? YesNo Do you hold your RYA Coastalskipper/Yachtmaster (Shorebased) Certificate? YesNo Please outline your powerboating experience... [/group] [group watersafety] Please select your normal clothing size —Please choose an option—XSSMLXLXXLXXL+ Please select your shoe size —Please choose an option—4567891011121313+ Can you swim 100 meters unaided?YesNo [/group] [group stcw] Can you swim 50 meters unaided?YesNo Can you tread water for more than 2 minutes?YesNo Are you currently listed with any crew agency organisations? YesNo [/group]
a. Have you ever suffered from epilepsy or unexplained loss of consciousness? YesNo
b. Do you have asthma? YesNo
c. Do you have diabetes? YesNo
d. Have you ever been diagnosed with angina, suffered a heart attack or any other heart condition? YesNo
e. Do you suffer from any musculoskeletal problems, such as back or neck pain? YesNo
f. Do you have a medical condition not covered in the above? YesNo
g. Do you have any mobility issues you feel could impact your course? YesNo
h. Do you have any other issues you feel could impact your course? YesNo
[group medical-yes clear_on_hide] Please provide more information… [/group]
Do you give consent for any photographs taken during the course, to be used for social media and marketing purposes? YesNo
Do you consent to the above information being used to contact you regarding upcoming courses, promotions and offers? YesNo
Where did you hear about Bristol Maritime? —Please choose an option—Google or other web searchSocial MediaReferralReturning CustomerLocal MarketingEventOther
I have read and agree to the terms and conditionsRead T&C's
I declare that the responses I have provided are correct and to the best of my knowledge and that I know of no health reason which will prevent me from undertaking this course. I will also immediately inform my instructor if I have any difficulties during the course.
Username or email *
Password *
Remember me Login
Lost your password?
