Dwyryd Trip Booking Form April 12th 2024
Sign in to Google to save your progress. Learn more
Anita, Antur Natur
Full Name *
Gender/Title or Preferred Pronoun (e.g Ms, Mrs, Dr she/he/they etc)
Email Address *
Phone Number *
Postcode *
Address *
Date of Birth  *
MM
/
DD
/
YYYY
Previous kayaking or canoeing experience - please provide full details, if booking a beginner experience and you have no previous experience please indicate your typical weekly levels of activity.  *
Please provide details of medical conditions /allergies / injuries / disabilities/ mental health conditions/ additional needs/ relevant cultural or religious requirements *
What canoeing equipment of your own you will have with you. State 'none' if you don't have any or are not sure.
 *
Please tell us your clothing size, weight and height - to help us ensure we provide you with equipment that will fit you.
 *
Emergency Contact (name & phone number)
 *
To provide you with a record of your day and for marketing purposes; Antur Natur instructors would like to take and use photo and video material of you. Please select yes to allow us to take and use these photographs.
 *
Antur Natur take all reasonable steps to minimise risk and are insured through Canoe Wales to deliver paddlesports. I understand that paddlesports may be hazardous with a risk of personal injury. I am aware of and accept these risks and will be responsible for my own actions and involvement. I  understand that it is my responsibility to arrange travel or personal accident insurance if I would like it. I am physically and mentally fit for the course I have chosen. If anything changes between completing this booking form and starting a course, it is my responsibility to inform Antur Natur. By writing my name in the box below it will be deemed that I have signed to declare that I am aware of the risks associated with participating in this activity and wish to participate.
 *
Today's Date *
MM
/
DD
/
YYYY
Please add me to your email list so that I can receive occasional email updates that include details of forthcoming trips and courses. Anita, Antur Natur does not share these contact details with anyone else.  *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Antur Natur. Report Abuse
Google Forms