IMC SAILING CAMP – Bulgaria 2014
Registration Form
Please forward this form by May 31 2014 to:
BNC via (National Association affiliated to IMC)
MR Pavel Dimitrov
14 B Seliolu str. et.1 ap.2 FAMMAC
9002 - Varna CC.19
Bulgaria 15 rue de Laborde
75398 PARIS CEDEX 08
Participant - first name ...... family name……………...... ……...………
Date of Birth …………………………. Place…………………………...... …………..
Gender: ( ) Male ( ) Female
Address………………………………………………………………………………..
…………………………………………………………………………………………..
Phone (home)...... mobile......
E-mail………………...... ………………………….……………..
Languages spoken (and level)......
Declaration :
The Participant declares that:
I am able to swim
I exempt the organisers from any liability in case an accident occurs during the Sailing Camp
I have personal insurance cover for travel, medical and personal liability
I understand that I may not use tobacco or consume drugs and alcohol during the camp
I will respect the rules and orders necessary for the safe running of the camp
Signed ...... Date ......
Enclose with this form:
1. Authorisation form if the participant is under 18 years of age on July 31st 2014
2. Health Certificate
3. Travel Plan
4. Copy of a valid passport or ID card
5. Copy of voucher for payment
IMC Sailing Camp – Bulgaria 2014
Authorisation Form
Name of the legally responsible adult……………...... …………………………..
As the Mother / Father / Legal Guardian…………………………………………………..
Of the Participant (name) ......
Birth date ......
Address…………………………………………………………………………………….
………………………………………………………………………………………………
Phone ......
E-mail…………………………………………...... ……………..
I hereby
1. Authorise the above mentioned young person to take part in the IMC Sailing Camp in Bulgaria from July 31st to August 11th 2014.
- Authorise / does not authorise the above mentioned young person to return home on
his / her own at the end of the IMC Sailing Camp.
- Authorise to take part in all the activities arranged for the camp.
4. Agree to exempt the organisers from any responsibility in case of an accident should occur during the IMC Sailing Camp.
5. Declare that the participant is able to swim in a sufficient skill (copy of proof of swimming ability is enclosed if available).
6. Declare the above mentioned young person is in good health and physical condition and can participate without limitation in the activities of the camp.
7. Declare that the participant has the necessary insurance cover for travel, medical and personal liability.
Signed ...... Date ......
IMC Sailing Camp – Bulgaria 2014
Health Certificate
I declare that the participant is in good health sufficient to undertake strenuous water sport activity such as sail training, canoeing and rowing.
( ) The participant has no dietary requirements
( ) Dietary requirements as follows:
......
Remarks:
......
......
......
......
Signed ...... Date ......
The IMC recommends that this form is signed by a qualified medical professional ( doctor, nurse etc.) or it may be signed by the responsible adult or self certified by those over 18 years on the date the form is signed.