PTBO PTBO TASTER BOOKING FORM Elton SC are organising a Push the Boat Out day in May 2019. This gives members of the public an opportunity to have a go at sailing in a safe and welcoming environment. Elton Sailing Club is an RYA Training centre. All equipment and instruction will be provided for this taster session by the Club. EVENT DETAILS SATURDAY 4th May 2019 10.00am to 4.00pm | Event Co-Ordinator : Geoff McLardy MAIN PARTICIPANT CONTACT DETAILS Name Address Street Address Address Line 2 City State / Region / Province ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao, People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe Country Phone Email Address If you are under 18, your parent or guardian must complete and sign the Parent/ Guardian Consent Form at page 3. ABOUT YOU Boating Experience Yes No Do you have any previous boating experience or qualifications? Experience Info If yes, please give brief details Can you swim 25 meters? Yes No Medical Conditions or Physical or Mental Impairments Yes No In the interests of your safety do you have any medical conditions or physical or mental impairments that the Organiser needs to be aware of that may affect your ability to take part in the PTBO Event? (If you answer yes please provide further details in the Medical Information and Impairments section of this form at page) Telephone number of emergency contact ABOUT OTHERS in your group (from the same address) Group Members Please provide your group members names and their previous boating experience and/or qualifications Please ensure each member in your group provides details of any medical conditions or physical or mental impairments that the PTBO Organiser needs to be aware of that may affect their ability to take part in the PTBO Event in the Medical Information and Impairments section of this form below BOOKING TERMS 1. RISK STATEMENT It must be recognised that sailing is by its nature an unpredictable sport and therefore inherently involves an element of risk. By taking part in the PTBO Event, you agree and acknowledge that: You are aware of the inherent element of risk involved in the sport and you accept responsibility for exposing yourself to such inherent risk whilst taking part in the PTBO Event; You will comply at all times with the instructions of the PTBO Event Co-ordinator particularly with regard to instructions for boarding and leaving the boat and/or launching and recovery (as relevant), using the equipment on the boat and handling sails, wearing of buoyancy aids, lifejackets and the wearing of suitable clothing in particular footwear for the conditions; You accept responsibility for any injury, damage or loss to the extent caused by your own negligence; You will not participate in the PTBO Event if your ability to participate is impaired by alcohol, drugs or if you are otherwise unfit to participate; You will inform the PTBO Event Co-ordinator if there have been any changes to the information provided on this form at the time of the Event. The provision of supervision by the PTBO Organiser is limited to such assistance, as can be practically provided in the circumstances. You understand that the PTBO event is intended to give participants a chance to experience sailing or windsurfing. You will be offered the chance to take part in the activities under the guidance of a representative of the PTBO Organiser who has been assessed by the organiser as competent and sufficiently experienced to supervise your experience. These representatives may not be qualified instructors. The PTBO event is not intended to provide tuition or instruction. You are aware of any specific risks drawn to your attention by the PTBO Event Co-ordinator. The Organiser very much hopes that you will enjoy the PTBO Event and will be able to advise you on how to obtain tuition and instruction should you wish to take your experience to the next stage. 2. CANCELLATION You understand that the PTBO Event Co-ordinator may cancel or postpone the PTBO Event at any stage in the event of bad weather, equipment failure or otherwise. 3. MISCONDUCT You understand that the PTBO Event Co-ordinator may exclude anyone from a particular session and evict anyone from the premises who refuses to comply with these Booking Terms or who misconducts themselves in any way or who causes damage or annoyance to other persons. DATA PROTECTION If you would like to be included on this mailing list please tick here. If you wish to withdraw your consent at any time, please contact dp@eltonsailingclub.co.uk The PTBO Organiser has a Data Privacy Policy which can be found at www.eltonsailingclub.com/privacy. Your data will be stored and used in accordance with that policy. The information you provide in his form will be used to facilitate your participation in the PTBO Event and to contact you. The Organiser would also like to include your contact details on a mailing list in order to make you aware of membership opportunities and future events. PHOTOGRAPHY If you consent to the use of images of you being used for this purpose, please tick here The PTBO Organiser may arrange for photographs or videos to be taken at the PTBO Event and published on the Event or Organisers website or social media channels to promote the Event or Organiser. This imagery may also be used by the RYA in connection with the promotion of its activities. If you are taking part in the PTBO Event as a family, your family members, aged 18 and over, should indicate their consent to the use of their image separately below. Family Member Family Member Family Member PARENTAL/GUARDIAN CONSENT (if children under 18) If you consent to the use of your child’s image being used for the purposes above please tick here. By consenting to the use of your child’s image being used, you confirm that that your child is not under a court order which may prevent their image from being published. If you/ the individuals listed above later wish to withdraw consent, please contact dp@eltonsailingclub.co.uk. Please be aware that if you later decide to withdraw your consent it will not be possible to remove your image from any printed material in circulation, or until the next edition or print of the item containing your image is released. By agreeing to your images being used, you agree to assign any copyright or any other right of ownership of these images to the Organiser. AGREEMENT (to be completed by all persons over 18) Group Member 1 First Last I confirm that I have read and fully understand the above Booking Terms and agree to comply with them. Group Member 2 First Last I confirm that I have read and fully understand the above Booking Terms and agree to comply with them. Group Member 3 First Last I confirm that I have read and fully understand the above Booking Terms and agree to comply with them. Group Member 4 First Last I confirm that I have read and fully understand the above Booking Terms and agree to comply with them. PARENTAL/GUARDIAN AGREEMENT (if children under 18) Name of parent/guardian completing this form First Last Relationship to participant Supervision (tick one box) I will be responsible for my child throughout the event. I will be available at the event venue I appoint the person named below, who has agreed to act in loco parentis. He/she will be responsible for my dependant throughout the event. He/she will be available at the event venue Name of person appointed in loco parentis First Last Mobile Number I agree that the below children may take part in the Event. I confirm that I have read through the above conditions with him/her and that she/he understands and agrees with them. I also confirm that he/she takes part in the Event with my full agreement that that the particulars given above are correct and complete in all respects Parent/Guardian Confirmation First Last MEDICAL INFORMATION AND IMPAIRMENTS If you declared that you have a medical condition or physical or mental impairment that the organiser needs to be aware of because it may affect your ability to take part in the Event please provide details below.