Volunteer / Instructor Registration Form
Personal Details
Forename :
DoB :
Surname :
Address 1 :
(dd/mm/yyyy)
Address 2 :
Town
County :
Postcode :
Telephone/Email contact
Home:
Mobile:
Email:
Emergency contact 1
Name :
Home telephone :
Relationship :
Mobile telephone :
Emergency contact 2:
Name :
Home telephone :
Relationship :
Mobile telephone :
Health Declaration:
It is important that Neptune Sailing knows whether you suffer from any illness, disability or medical
condition that may affect you whilst you are working with the organisation. Please indicate in the space
below otherwise enter ‘None’:



Any medication you are currently receiving, include details & dosage.
Any medication that you may take on the water during activities e.g. Inhalers, Epi-pens, Angina, so we
can help you to self medicate should the need arise.
Any condition that may arise that could effect you e.g. heart conditions, epilepsy, diabetes etc
I declare that I am not suffering from any medical, physical or mental impairment which has an adverse effect
on my abilities to properly discharge my duty of care as an instructor, volunteer or helper. I undertake to
inform the RYA & Neptune Sailing if this changes and agree to submit to a medical examination if requested
by the RYA.
Signature :
Date:
ver 01/13
Registered Address: Neptune Watersports Centre, Cat House Lane, Woolverstone, IP9 1AU
Company number: 8012364
Charity number: 1148791
Qualifications
Sailing
Date Issued
Expiry Date
Date Issued
Expiry Date
dd/mm/yy
dd/mm/yy
dd/mm/yy
dd/mm/yy
Assistant Dinghy
Instructor
Keelboat
endorsement
Dinghy Instructor
( Coastal )
Multi Hull
endorsement
Advanced Dinghy
Instructor
Race Instructor
endorsement
Race Coach Level 2
Keelboat Instructor
(Coastal)
Senior Dinghy
Instructor (Coastal)
Senior Keelboat
Instructor (Coastal)
Powerboat
Level 2
(Coastal)
Instructor
Safety Boat
(Coastal)
Advanced
Instructor
Intermediate
Powerboat
Trainer
Advanced Powerboat
Other RYA Qualifications
VHF Radio
First Aid Instructor
1
3
2
4
Safeguarding
Enhanced CRB
No:
NB: If you do not have a CRB please complete the self-disclosure form
Safeguarding training
Please provide copies of all qualifications, preferably scanned images, with your registration
form
ver 01/13
Registered Address: Neptune Watersports Centre, Cat House Lane, Woolverstone, IP9 1AU
Company number: 8012364
Charity number: 1148791