POWERBOAT LEVEL 2

POWERBOAT LEVEL 2

Registration Form
Please choose your course dates:

August dates to be confirmed
Personal information*

PrefixFirst NameLast Name
Adress*

Number and name of the street

Additional address information

CityState/Region

Postcode
Date of birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Occupation*
E-mail*
Medical information

All of the practical courses we run require un certain level of physical activity and the waves and wash the vessels pass over/through will create impacts on your body. If you have any concerns about your ability to take part in the course due to health or fitness reasons you should consult with your doctor and consider whether the course is appropriate for you.
Have you any health issues or disability?*

YesNo
Are you currently taking medication (if Yes what for)?*

YesNoAutre
Do you suffer from any of the following?*

Shortness of breathChest complaints e.g. bronchitis / asthma?yesNo
Previous heart complaint, surgery or angina?*

YesNo
Fits / fainting / dizziness?*

YesNo
Any problems with mobility?*

YesNo
Any significant disease, infection e.g. diabests, ear infections etc?*

YesNo
Are you taking any medication/pills/injections which may affect your participation?*

YesNo
Did you feel unwell at the moment?*

YesNo
Details of any medical treatment being received, or conditions that we may need to be aware of, if you are taken ill during a course. If there are none then write 'None'.*
Emergency contact*

FirstLast name
Relationship to you ?*
Mobile phone number*

Indicatif régionalNuméro de téléphone
Anything you would like to tell us (preferred dates, etc)?
Where did you find this course ?

La Belle Classe Academy emailYCM logbook emailLinkedInFacebookInternet searchYotspotInstagramYCM facilitiesWord of mouthOcean Wave MonacoPhoenix Yacht ManagementOther
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The Information you provide us with is used only to handle your request. We undertake to keep your data secure and strictly confidential. We will never sell or hand it over to a third-party company. All our digital data processes have been declared to the CCIN (Commission de Contrôle des Informations Nominatives) by a compliance undertaking. Under Law n°1.165 of 23 December 1993, amended by Law n°1.353 of 4 December 2008, relating to data processing, files and civil liberties, you have a right to access, consult, change, rectify and delete information you have given us. To do this, you can send us your request by email to the following address: dpo@ycm.mc.
La Belle Classe Academy

Quai Louis II MC 98000 Monaco

Telephone number: +377.93.10.70.08

academy@ycm.org | www.ycm.org
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