booking Form

PLEASE COMPLETE THIS FORM IN BLOCK CAPITALS

Course and dates ………………………

Name

Address…………………………………

Post code: ………………………….

Daytime Tel. No. Std codes & extension

Mobile Tel No…

E-mail @

Age ……… Date of Birth _ _ / _ _ / _ _

Gender : M or F (delete as appropriate)

Please give us some details of your
previous experience in the particular activity:

.......................................

Please inform us of any health problem or condition which:

• May be adversely affected by physical exercise..

• May be adversely affected by weight carrying ........................................................................

• Is being controlled by medication ..

• Involves your circulatory, respiratory, nervous,
or skeletal system, recent injury, illness or complaint ……………………………………………………………………………………………

• If you are allergic to any medication, please specify .

• Do you wear contact lenses or spectacles? Yes / No*
contact lenses / spectacles / both*

• Diet Vegetarian – Vegan – Allergies and any specific likes & dislikes …………………………………………………………………………………………………

• Foot size ………….
• Rock shoe hire required @ £5 per day Yes / No* (rock climbing courses only)

* delete as appropriate

Please give an emergency contact name and
phone number, in the event of your having an accident

Name……………………………………………… Relationship to you

Contact Numbers daytime Std codes & ext …………………………………………………

Evening …………………………………………………………………………………

Details of any relevant previous experience relating
to the activities you have chosen to participate in with dates.
(Please use extra sheet if required) ……………………………………………………

Terms relating to cancellation. I understand that bookings are accepted on the understanding that Twid's conditions of Use are observed. I accept that Twid is not under any liability whatsoever in respect of loss or damage to personal property, not caused by the negligence or default of either Twid, their suppliers, their agents, and employees whilst attending the course. I have had my attention drawn to the information on insurance cover terms and conditions.

I confirm that I have been made aware that it is my own responsibility to provide Personal Accident Insurance.(We strongly recommend that you are insured – see our website for a list of suggested insurers)

Print name …………………………………………………….. Signature …… Date ……….……………

Fees

The balance of your course fee is due 6 weeks before the start of your course. In the meantime, you should post us your DEPOSIT (40% of the full course fee or £400 ) along with this form.

The full fee for my course is £ ______

I am paying A DEPOSIT OF £ ______ if more than eight weeks to start of course, balance of £ ____ due 6 weeks before the start of the course

Equipment hire £ ______

Total due £ ______
I enclose a Cheque payable to Mike Turner for the appropriate amount.

Twid's use only

Booking number........................................................

Booking form returned and deposit paid
…………………………………………………………

Confirmation letter date posted _ _ / _ _ /_ _ _ _

Insurance certificate No …………………………………………………………………………………

Full payment Due

.........................................................

Full payment made and in what form