RYA PWC / JET SKI PROFICIENCY COURSE

RYA PWC / JET SKI PROFICIENCY COURSE

Registration Form
DATES OF YOUR CHOICE
WHAT TYPE OF COURSE?

GROUP (UP TO 3 PERSONS)INDIVIDUAL ONBOARDINDIVIDUAL AT YCM
CLIENT DETAILS*

FIRST NAMESURNAME
ADRESS*

STREET

OTHER

CITYCOUNTRY

POST CODE
PHONE NUMBER*

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

MoisJourAnnée
Date
OCCUPATION*
REQUESTED SESSION
Type in the session you wish to enroll in
MEDICAL QUESTIONNAIRE

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)?*

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
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'.
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.
EMERGENCY CONTACT

First nameLast name
RELATIONSHIP TO YOU?
PHONE NUMBER

Indicatif régionalNuméro de téléphone
YCM Member*

YesNo
If yes, please enter your code
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 MonacoPhoenix ManagementOther
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:*

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ANYTHING YOU WOULD LIKE TO TELL US?
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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