Medical - Do you have any medical condition, disability or injury of which we should be aware?
= yes = no - If Yes, please give details:

Experience - Please state previous experience of the activity of the chosen course:
= beginner = improver = advanced

Your Ethnic Background - I would describe my ethnic origin as:
= White = Black Caribbean = Black African = Black Other = Indian = Pakistani = Bangladeshi = Chinese = Other

I agree to you charging my credit/debit card: = yes = no

DECLARATION
I accept the booking conditions. (press here for details of booking conditions)
(Water activity courses) I am able to swim 50 metres in light clothing.
I am physically fit to take part, except for any medical problems which I have declared.
Refunds due to cancellation are in accordance with booking conditions.
The City Council accepts liability for loss, damage or injury resulting only from negligence by Southampton City Council, its servants or agents.