COURSE BOOKING FORM
To confirm your booking, please complete this form, sign overleaf and return it to us with your full course fee.
You can post it to: Tollymore Mountain Centre, Bryansford, Newcastle, Co. Down, BT33 0PT
You can fax it to us : 028 4372 6155
Personal Details
Name:.............................................................................................................................................
Address:..........................................................................................................................................
......................................................................................................................................................
Email address:..............................................................................................................................
Date of Birth (if U18):............/............../............
Telephone:...............................(H) .........................................(W)............................................(M)
Details of any special dietary requirements:.....................................................................................
Name of Course:............................................................................................................................
Start Date of Course:.................................................... End Date:.................................................
If you are booking on a WGL, ML / SPA / RCLA / WML or MIA training or assessment course, we need your MLT Registration Number
MLT Registration Number:..................................................
If you are booking on a Canoesport Coaching training or assessment course, we need a copy of your stamped C1
Please circle discipline if you are applying for a canoesport course:
Canoe Kayak Surf Sea
Name and telephone number of a person we can contact in the event of an emergency:
Name:............................................................ Tel:......................................................................
Are you happy to have your contact details supplied to other course participants who may wish to share transport to and from Tollymore Mountain Centre YES / NO
We will automatically send you regular email newsletters about Tollymore Mountain Centre. Would you like to receive these newsletters YES / NO
How did you find out about this course (please circle): Past visit Newspaper advert Postcard
Tollymore programme Flyer Word of mouth Magazine article Web search
Other (please specify):..................................................................................................................
COURSE FEE
We cannot confirm your place on any course until we receive the full course fee. The fee for my course is £_______ I am booking at least two months in advance and would like a 20% discount on my course fee Yes / No
Course fee payable: £_______
Method of Payment
1. Course Fee enclosed. Cheques and postal orders made payable to Sport Northern Ireland
OR
2. I authorise you to charge my credit card with the amount due. (Please note that we can accept Visa, MasterCard and Switch)
Card type:..................................................... Card number:..........................................................
Expiry date:................................................ Name on card:...........................................................
Card holders signature:..................................................................................................................
OR
3. Invoice to sponsoring organisation
Name of Organisation.....................................................................................................................
Address for Invoicing:....................................................................................................................
....................................................................................................................................................
Authorising Officer: Name:..........................................Position:.......................................................
Authorising Signature:...................................................................................................................
Applications will not be accepted unless accompanied by an official purchase order or letter of authorisation from your employer.
TERMS AND CONDITIONS
Course Participant Medical Condition
The training undertaken at Tollymore Mountain Centre often involves strenuous physical exercise. Participants can be exposed to cold and wet conditions and circumstances where the carrying of heavy loads is required. Applicants should seriously consider their personal health and fitness prior to attending a course. Anyone suffering from or ever having suffered from any medical condition, illness or injury or who is pregnant should consult their doctor regarding the suitability of their participation. Participants with concerns should only attend following positive advice from their doctor and should make their condition known to the centre staff via this form. Do you have of any medical or physical condition, previous injury, or treatment regime that you think may affect your participation on your chosen course, or on the possible application of first aid / medical treatment in the unlikely event that you are involved in an accident. Please circle appropriately. Yes No
Please give us details:.....................................................................................................................
.....................................................................................................................................................
If you have answered yes, please ask your doctor to complete the section below:
Your patient:................................................................................................... (patients name) has applied to participate on........................................................................................................ (name of course). This course may involve strenuous physical exercise, exposure to cold and / or wet conditions and the lifting of heavy loads. Will their stated condition above, or any medical treatment that they are on, preclude them from participation on the above course? Yes No
Signed:................................................................Tel. No.:.............................................................
Course Fees
Course places are only confirmed on receipt of a completed application form, plus the appropriate course fee.
Cancellations
Cancellation by client
- All cancellations must be in writing
- Tollymore will try to resell the course place. If the course fee is resold, the client will receive a full refund less an administration charge of £25
- Refunds will only be made after the start of the course
- Cancellations more than 4 weeks prior to the start date of the course receive a full refund less the administration charge
- Cancellations between 2 and 4 weeks prior to the start date of the course receive a 50% refund less the administration charge
- Cancellations within 2 weeks of start of course – no refund
Cancellation by Tollymore
- Tollymore will make every attempt to ensure that advertised courses run. However Tollymore will notify course participants at least two weeks prior to the start date of any course if it is not possible to provide the course.
- In the event of cancellation, participants will be offered either a) a full refund or b) another course on different dates.
I understand that neither Sport Northern Ireland nor its servants, agents or employees is under any liability in respect of personal injury, loss or damage arising out of the hiring of the facilities unless such personal injury is a result of a negligent act of Sport Northern Ireland, its servants, agents or employees. Sport Northern Ireland holds full public liability insurance. If you wish to take out personal accident cover, please contact an insurance broker.
I have read and understand all the booking conditions and advice contained herein.
Signed:.........................................................Date:.........................................................................
Signature of parent or guardian if under 18:......................................................................................
If you are signing for someone under 18, please check that you have enclosed details of relevant medical or other conditions, and contact us for a parental consent form which we will send to you.
MONITORING INFORMATION
Tollymore Mountain Centre is required to report on the effectiveness at attracting course participants from all sections of the community and we would be grateful if you provbide us with the information requested below.
The information collected will be held in a de-personalised data-base and will be treated in the strictest confidence.
1. Gender (please circle) Male Female
2. Age (Please circle) U18 18-25 26-35 36-45 46-55 55–65 66+
3. Postcode:.........................................
4. To which of these groups do you consider yourself to belong (please circle):
White
Bangladesh
Irish Traveller
Indian
Chinese
Black African
Pakistani
Black Caribbean
Ethnic (other)
Black (other)
5. Do you consider yourself to have a disability (please circle): Yes No
Data gathered on this form will be held in accordance with regulations of the Data Protection Act 1998.