Booking Form Date Course Name* First Last Please gives names (and ages if under 18) of other participants in this booking.British Canoe Membership Number (if applicable) Date of Birth DD slash MM slash YYYY Only required if a British Canoeing member wanting a certificate. Certificate Fees* I am aware I need to bring cash if I want a certificate. Please read booking confirmation for exact details. (First Aid course certificate fee included) Mobile Phone*A number that you can be contacted on on the day of your booking encase anything changes such as adverse weather.Address* Street Address Address Line 2 City County Post code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email Please give any further information you feel we should be aware of before the course.*Please give details of your paddling experience, water confidence and any relevant medical information including allergies and dietary requirements that we can try and accommodate for if we are providing food/ brews. Also, if there is anything from a learning / teaching perspective that we can support you with. Covid-19 - Please tick to say you have read and confirmed the following information.* I confirm I have read and understood the information regarding Covid-19. If you are presenting with coronavirus symptoms (high temperature, new continuous cough and loss or change to your sense of smell or taste) please do NOT attend. We are happy to rearrange the session. Please wash your hands before attending the session. Please bring your own hand sanitiser to use before and after the session. Please avoid touching your face, nose, ears, eyes and mouth before, during and after the session. Please follow stringent 2 metre social distancing. Please bring your own small first aid kit for minor injuries you can deal with- plasters etc. All equipment will be washed and cleaned before and after each session. All paddles and buoyancy aids and leashes will be left for a period of minimum of 72 hours before being used again. Quantity*Please enter number of places you are booking for. Product Name Price: Total £ 0.00 Payment* Card Invoice Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Invoice Details (Name & Address)Terms & Conditions* I have read the T&Cs. By ticking this box you are confirming you have read the terms and conditions including cancellation fees. Photo Consent* Yes No Photos maybe used on social media such as Facebook and Instagram along with advertising through our website and any other Rooted in Nature CIC marketing. Emergency contact number*Please provide an emergency contact number of someone not on the course
