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Course name*

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Course Dates

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Course Location

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Course ID

Applicant’s Details

Membership Number (if known)

Title*

First Name*

Surname*

Preferred Name (if different to first name)

Email*

Enter Email Confirm Email

Mobile Phone*

Member Type*

Youth (under 18)
Adult (18 & above)

Pre-requisite Information

Pre-requisite Information **

I have completed all prerequisites for this course *

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I have read the details of my application and I confirm that I have completed ALL prerequisites required for this course.*

I have completed all prerequisites for this course *

Payment

Payment Option*

Credit Card (Training Team will be in contact to arrange payment)
Invoice to Group
Young Leadership Development Program

Other information

In case of accident please give the name of a relative or friend who may be contacted

Emergency Contact Name*

Relationship*

Emergency Contact Landline

Emergency Contact Mobile*

Do you have any physical disability or condition that the Course Leader should be aware of?*

Yes
No

Please provide details

Do you have any special dietary requirements that the Course Leader should be aware of?*

Yes
No

Please provide details

Are there any other special requirements that the Course Leader should be aware of?*

Yes
No

Please provide details

Do you require accommodation prior to the start of the course?*

Yes
No

Please provide details

Parental Consent (for Youth Member applicants)

I give permission for the above named applicant to attend this activity and that all information in this application is up to date.*

Yes

I consent his/her participation in (if applicable):

Swimming
Water/boating activities
Rock activities
Abseiling

I acknowledge that this activity will involve inherent and obvious risks.*

Yes

In the event of medical assistance, treatment, and/or hospital accommodation I agree to pay the Association on demand all such doctors', dentists', nurses', ambulance and hospital fees (other than fees and expenses recoverable by the said Association under any policy of insurance).*

Yes

I confirm that I am over the age of 18 years.*

Yes

Signature of Parent or Guardian*

Please draw your signature in the box below.

Name of Parent / Guardian*

Parent / Guardian Mobile*

Signature

Signature*

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Date

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Training Course Application (L1)

L1 Training Course Application Form

Applicant’s Details

Pre-requisite Information

Payment

Other information

Parental Consent (for Youth Member applicants)

Signature

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