Register Your Interest

Personal Details Name:


Address:


Phone Number:


Email:


Date Of Birth:


Age:


Education & Qualifications Please give details of any qualifications you have obtained:


Present / Previous Employment Please give brief details of your employment:


Professional Qualifications / Memberships Please give details of relevant qualifications held and detail membership of any national governing body:


Courses Attended & Certificates Obtained Please detail any relevant courses you have attended or certificates received:


Kayaking Experience Please detail any kayaking or canoeing experience you have:


Climbing Experience Please detail any outdoor or indoor climbing experience you have:


Mountain Leader Experience Please detail any mountain leader, navigation or walking experience you have:


General Information & Special Interests Please give brief details of why you wish to enrol on this course and any other information that you would like us to consider:


Criminal Offences & Convictions Have you been convicted of any offences covered by the 1974 Rehabilitation of Offenders Act?


Do you hold a current CRB Enhanced Disclosure Document?


Driving License Do you hold a current British driving license?


If so, when did you pass your test?


Driving License Number:


Have you had experience driving a minibus?


Do you hold a current PSV license?


Is your driving license 'clean'?


If 'No', please give details of any endorsements, stating the nature and date of offence and details of any fine or penalty incurred:


Medical Details Have you been absent from work for more than 3 consecutive days in the last 3 years?


Do you have any medical condition that may prevent you from fulfilling any duties that may reasonably be expected of you?


Do you have any disabilities/conditions that may affect your application or future work in the industry?


If you have answered 'Yes' to any of the above questions, please give further details:


Further Details Will you require full board accommodation in our 18th Century Manor House?


Why would you like to pursue a career in the Outdoor Industry?


All prospective students are invited and encouraged to visit the Centre and meet the Course Director; When would you like to come down and see us? Please list some dates that you would be able visit the centre:


Declaration I hereby declare that the information given on this form is true, complete and correct, to the best of my knowledge. Any false statement or information withheld may be sufficient cause for rejection or dismissal from the course without notice or refund of course fees.

Your Full Name:


Date:

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