WRG Canal Camps: Booking Form

Please print out this booking form, complete and send to WRG (address below)

First name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surname . . . . . . . .  . . . . . . . . . . . . . . . . . . . .

Permanent address . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postcode . . . . . . . . . . . . . . . . . . . . . . . . .

Tel. no. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mobile no. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Note: if you wish correspondence prior to the Camp to be directed to any other address, please give

details and dates on the reverse of this form.

Occupation . . . . . . . . . . . . . . . . . . . . . . . . e-mail address . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Would you like to subscribe to the WRG email mailing list? YES/NO

Date of birth . . . . . . . . . . . . . . . . . . . . . WRG Id number (if known) . . . . . . . . . . . . . . . . . . . . . . .

I wish to attend camp no:

                      . . . . . . . at: . . . . . . . . . . . . . . . . . . . . . . . on dates: . . . . . . . . . . . . . . . . . . . . . .

                      . . . . . . . at: . . . . . . . . . . . . . . . . . . . . . . . on dates: . . . . . . . . . . . . . . . . . . . . . .

Cost of camps 2008: Camp 22 £70; all others £49

Either: I enclose payment of £. . . . . . . . (Please make cheques payable to ‘WRG’)

Or: Please debit my Visa / Mastercard number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

expiry date: . . . . . . . . . . . . . . . . by the sum of £ . . . . . . . .

Any special diet? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Are you attending this camp as part of your Duke of Edinburgh’s Award? YES / NO

Have you been on a Canal Camp before? YES / NO

If YES, how many/where/when? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Do you suffer from any medical condition or illness? YES / NO

Are you receiving treatment or under medical supervision for any condition? YES / NO

If YES to either question, please give comprehensive details in a covering letter including information

about any prescribed medication and its dosage. This information is given in confidence, although

may be shared with WRG's insurers.

How do you intend to travel to the camp? CAR / COACH / TRAIN / OTHER . . . . . . . . . . . . . . . . . . .

How did you first hear about Canal Camps? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

In the unlikely event that you should injure yourself during the camp, whom should we contact?

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tel. no. . . . . . . . . . . . . . . . . . . . . . . . . . .

Please read the following before signing: I agree that information on this form may be stored on an

electronic database and that this information may be provided to the organisers of the camp that I will

be attending and to other authorised WRG Personnel. WRG may use the information you supply for

administrative purposes and to send you information about our activities. We promise not to sell your

details to anyone else.

Signed (parent’s signature necessary if you are under 18)

(Bookings will not be accepted on unsigned forms) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .