Watersports Registration *Compulsory Information required.Please register your details below for all watersports - open water swimming, sailing, windsurfing, kayaking, canoeing and climbing and wakeboarding. Activity Wakeboarding Other Activity Title * - Select -MrMrsMissMsMasterGroupSchoolUnknown First name * Last name * Street * Locality * Town * Post code * Telephone * Mobile phone Email * Birth date * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018 Does the participant have a disability? Yes No State disability - None -Health ImpairmentModerate Learning DisabilityVisual ImpairmentHearing ImpairmentSevere Learning DisabilityOther/Not SpecifiedUndisclosedPhysical Disability/ImpairmentNoneRegistered Disabled Does the participant suffer from any health problem, disability or special need? Yes No If yes, please give details If yes, please provide Aspire or Freedom swipe card number? Emergency Details - In case of emergency contact: Name * Relationship * Mobile * Alternative number Confirm fitness * * I confirm that the participant is physically able to take part in watersports, climbing and/or wakeboarding Confirm photo publicity I consent for photographs and/or video to be used for Salford Community Leisure publicity. Confirm age * I confirm that I am over 16 years old and am able to register for watersports, climbing and/or wakeboarding at Helly Hansen Watersports Centre * I give consent for the above person (aged 16 years and under) to register for watersports, climbing at Helly Hansen Watersports Centre Opt in to marketing Please tick here if you want us to keep you posted via email about Salford Community Leisure’s upcoming activities and exciting events as well as special offers. You will be able to withdraw your consent at any time via email