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Youth
Open Training 2-3 March
Cymraeg
Open Training March 2-3
Personal Details
Please note: All required fields are marked with an
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Name
*
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Sailing Club
*
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Class
*
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Sail Number
*
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Date of Birth
*
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Height (cm)
*
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Weight (kg)
*
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Gender
*
Male
Female
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How long have you been sailing / racing?
*
What are your best results?
What certificates or badges do you have?
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Welsh Skills
Understand
*
Fluent
Quite well
A little
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Read
*
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Speak
*
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Write
*
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Contact Details
Email Address
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Postal Address
*
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Home Telephone No.
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Mobile No.
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Postcode
*
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Parents' or Guardians' Phone Numbers:-
Work
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Work
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Mobile
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Mobile
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Volunteers needed!
Please note all parents/guardians will be asked to sign up to a rota to keep the club clean and tidy at the end of the day.
Name
Qualifications / Skills offered
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Medical Details
Doctor
*
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Telephone No.
*
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It is your responsibility to make known any potential medical conditions that may affect you during the activities associated with the programme you will be taking part in. Please therefore provide as many details as possible. This information will be shared with the coaches at events and training.
Have you ever suffered from any of the following conditions:
Asthma / Bronchitus
*
Yes
No
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Heart conditions
*
Yes
No
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Fits, fainting or blackouts
*
Yes
No
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Severe headaches
*
Yes
No
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Diabetes
*
Yes
No
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Travel sickness
*
Yes
No
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Allergies to Medication
*
Yes
No
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Any other allergies
*
Yes
No
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Other illnesses or disabilities
*
Yes
No
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If you have answered yes to any of the above, please provide details:
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If you are currently taking any medication, please specify:
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If you are suffering/recovering from any injuries which may affect your involvement with the programme, please specify:
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If you are vegetarian or have any food allergies, please specify:
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Consent
Please get a parent or guardian to read the following declaration and fill in the rest of the form.
As the parent/guardian of the person named above, I give permission, to the Clwb Hwylio Pwllheli Sailing Club appointed supervisor, to administer to the named person, any treatment or medication when or if necessary.
Further, if the case arises I authorise the Clwb Hwylio Pwllheli Sailing Club appointed supervisor to take the named person to hospital and give my full permission for any treatment required, to be carried out in accordance with the hospital’s diagnosis. I understand that I shall be notified, as soon as possible, of the hospital visit and any treatment given by the hospital.
Parent / Guardian Name
*
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Date
*
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Calon Hwylio Cymru ~ Heart of Welsh Sailing
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