Summer Sea School - Registration Form

SUMMER YACHTING CAMPS

Registration Form
CLIENT DETAILS*

FIRST NAMESURNAME
Are you a YCM member?*

OuiNon
Please enter your code :
ADRESS*

STREET

OTHER

CITYCOUNTRY

POST CODE
PHONE NUMBER*

AREA CODEPHONE NUMBER
EMAIL*
exemple@exemple.com
DATE OF BIRTH*

JourMoisAnnée
Date
NATIONALITY*
INDICATE COURSE DATE*

From 7th to 11th July: Yachting Activity Week (1250€) - Fully booked, add me to the waiting list!From 14th to 18th July: STCW Basic Safety Training Week (1100€) - 4 spaces left!2 Week Deal (2100€)
Please submit a copy of your passport with this document*

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MEDICAL QUESTIONNAIRE
Have you any health issues or disability?*

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

YesNoOther
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. diabetes, ear infections etc?*

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

YesNo
Do you feel unwell at the moment?*

YesNo
EMERGENCY CONTACT*

FIRST NAMESURNAME
RELATIONSHIP*
RELATIONSHIP TELEPHONE*

Indicatif régionalNuméro de téléphone
THE UNDERSIGNED CONFIRM THE ABOVE ANSWERS ARE CORRECT TO THE BEST OF MY KNOWLEDGE
Any medical problems DO need to be reported to the Instructor.

This medical questionnaire MUST be completed & returned to the course center.
Are you a student at the International University of Monaco?

YesNo
How did you find this course?*

La Belle Classe Academy emailYCM logbook emailLinkedIn La Belle Classe AcademyThrough Seascope FranceFacebookInternet searchYotspotInstagram YCMWord of mouthInternational University of MonacoOther
We collect this data in order to answer you in a satisfactory way. We also use your e-mail address to send you additional offers. To enable this, please tick the boxes below:*

I accept that La Belle Classe Academy of the Yacht Club de Monaco sends me by e-mail new products or services from their catalogue.I don't want to receive new products or services from the Yacht Club de Monaco
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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SUMMER YACHTING CAMPS