Private Bookings PayPal/ BACS Payments Date of course* Name of Course* Name* First Last British Canoeing Membership NumberDate of BirthDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Only required if a British Canoeing member wanting a certificate. 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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 will be willing on this occasion give a full refund. 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 a face mask/ covering. All equipment will be washed and cleaned before and after each session. Medical ConditionsAre there any medical conditions we need to be aware of? Please give details that will help us support you on the course. 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. Allergies and Dietary RequirementsPlease let us know if you have any allergies including anything that requires an epi-pen. Also, please let us know any dietary requirements/ food allergies that we can try to accommodate for. Emergency contact number*Please provide an emergency contact number of someone not on the courseCertificate Fees* I am aware I need to bring cash if I want a certificate. Please read booking confirmation for exact details. Payment* PayPal (finance@rootedinnature.org.uk) BACS payment (please email for details) Please let us know which method you have paid by. 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.
