Outdoor First Aid Booking Form.Please note your place will be confirmed subject to availability. Course Selection Which Outdoor First Aid Course would you like to book onto? Please note the course date. This course runs across 2 consecutive days, 9am - 5:30pm each day. About you Full name * As you wish to appear on your certificate. First Name Last Name Date of Birth * Email * All communication will be by email – please use an email address which can be accessed evenings, weekends and school holidays. Phone Number * Home Address Home Address line 1 * Address line 2 Town / City * Postcode Work Address Work Address line 1 Address line 2 Town / City Postcode * Course Fees and invoice Details Payment is required at the time of booking (or by return of invoice) to secure your place. If your organisation is paying for this training and you require an invoice, please give full details of whom to invoice, email address, together with a relevant purchase order number For the attention of * First Name Last Name Email address * Purchase Order Number MEDICAL CONSENT Emergency contact name * First Name Last Name Emergency contact phone * Relationship to you * Doctor's name & Surgery * Doctor's Number * Your Blood Type & Rhesus Factor If known Have you had or do you have any of the following? * Check as many as appropriate Allergies of any kind Asthma or breathing difficulties Diabetes Epilepsy, blackouts or fainting attacks Heart Condition Sensory Loss – sight, speech or hearing Vaccination against Tetanus in the last 5 years Surgical treatment in the last 3 months Currently taking any medication I'm fit and healthy and don't need to inform you of anything Details If you have checked any of the above, please give details - including anything else that would be helpful for us to know about you. Terms & Conditions * To be held at the EarthCraftuk Forest School Site in Blean Wood between Canterbury & Faversham. (Full joining details will be sent once payment has been received) view T&Cs || view Medical Consent Declaration I agree to the terms and conditions I agree to the Medical Consent Declaration Thank you!