02392 17 4040
Full name
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Full Address
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How did you hear about us? GoogleKiteworld MagazineWord of MouthOther
Your Height (cm)
Your Weight (kg)
Fitness Level Very FitFitUnfitVery Unfit
Can you swim 50m? YesNo
Would you consider yourself water confident: ? YesNo
Are you a smoker? YesNo
How is your eyesight? GoodFair
Are you taking any medication? YesNo
If yes, what medication:
Do you suffer from and medical conditions or injuries that we need to be aware of whilst undertaking this activity such as Asthma, Diabetes, joint surgery, etc? YesNo
If yes, what medical condition(s):
Next of Kin relation
Declaration
I declare that the information given above is accurate and true, and that i have not knowingly withheld any information. I understand that to knowingly withhold information could result in the termination of my training without refund.