THECANOEMAN OVERNIGHT BOOKING FORM Office Use

Initial

DiaryCamping Diary

DepositBalance

Template EmailReminder Email Set

Transaction No

Date of Arrival:

toSite:

Trail/ Activity (ie bushcraft canoe trail):Group Leaders DetailsTitle/First Name/Surname:

Tel No:

Mobile No:

Address:

E-Mail:

Postcode:Emergency Contact Name:

Relationship:

Emergency Contact Number:

Name of Participant

(Including Leader)Age, only if Under 18Name of ParticipantAge, only if Under 18

1.11.

2.12.

3.13.

4.14.

5.15.

6.16.

7.17.

8.18.

9.19.

10.20.

Please specify arrangement of boats: (2 or 3 man canoes, single or double kayaks)

Accommodation Information

Canoe or Tipi Camping Trail OnlyTipi/Tent Hire (Or N/A if using own)

No. of people:Size of tent required:

No. of nights camping:Camping equipment for 4 people required: Yes/No

No. of days paddling:PLEASE NOTE any damage to equipment hired must be paid for and will be debited to the credit/debit card used to make this booking.

No. of tents you are using:

Medical Information Within The GroupAny past/relevant illnesses/injuries Yes/No If Yes, please give name and details below

Any past/relevant medical treatment? Yes/No If Yes, please give name and details below

Any allergies? (medicines, food, bee stings etc) Yes/No If Yes, please give name and details below

Any special dietary requirements? Yes/No If Yes, please give name and details below

Any disability? Yes/No If Yes, please give name and details below

Details:

Please Note: Staff are not permitted to give medication or painkillers.

Please give any further information you feel may be of use in an emergency or that our instructors/ guides should be aware of e.g. phobia, hyperventilation, diabetes, epilepsy, motion sickness, back injuries etc.

BOOKING CANNOT BE PROCESSED WITHOUT PAYMENT

50% payment required immediately upon booking, balance to be paid within 1 month of course date for all group payment over 100. If hiring camping equipment please include 25 per person refundable breakages. All group payment under 100 must be paid in full at time of booking.

Please make cheques payable to Norfolk Broads Tourist Information & Activity Centre: amount included: of total amount send to Norfolk Broads Tourist Information & Activity Centre, 10 Norwich Road, Wroxham, NR12 8RX

BACS transfer: sort code: 20-99-21, acc. no: 93475336 for the appropriate amount: please reference with your name and date of booking. Amount transferred: of total amount .Statement of Assumed Risk

To minimise these risks we have evolved a safe system of work We only employ fully qualified staff

We provide appropriate personal safety equipment for all participants

We provide appropriate equipment for the course

We work to National Governing Body guidelines in respect of instructor to student ratios

We have a robust risk management system in place

We reserve the right to cancel or modify any activity if we believe there to be adverse risk ie adverse weatherAnybody thought to be under the influence of alcohol or drugs will not be allowed to participate

Maximum payload per 3 seater canoe is 36 stone

For your safety and comfort we advise you bring sufficient food and drink with you and you read any joining instructions and kit list carefully to ensure you bring the correct clothing and footwear. Swimming ability: All participants taking part in water activities are equipped with buoyancy aids; therefore an inability to swim will not exclude you from taking part. However we do ask that you have a certain level of water confidence relevant to the activity. If you have any concerns about this please discuss it with your instructor.We fully understand that there are certain dangers involved in the use of a kayak or canoe that are beyond the control of TheCanoeMan and its employees, which may result in accident, injury, death or property damage either to myself or other persons. Such dangers include, but are not limited to, the possibility of capsizing which could result in drowning, the possibility of striking rocks or other objects which may damage or rupture the boat and the possibility of being exposed to the hazards of water level or weather changes (including rain, lightening, fog, high winds and rough water) which may cause hypothermia.

Data Protection Act 1998: The information you supply to us will only be used to process your booking and for our mailing list. If you DO NOT wish to receive further brochures or information, please tick the box.

Cancellations/Refunds All deposits are non-refundable and that no refunds will be issued for early returns, illness, weather or non-usage. Cancellations less than 5 weeks before the start day 40% of full payment will be refunded. Cancellations less than 3 weeks before the start day 25% of full payment will be refunded. Cancellations less than 2 week before the start day no refunds will be made.Loss or Damage. Be responsible for, and indemnify us against, loss of or damage to, or caused by the Goods whilst in your possession howsoever caused, and notify us as soon as practicable of any such loss or damage. We understand we are liable for all dirty, damaged, lost or stolen equipment and any fees associated with the listed equipment, and that all equipment must be returned in good condition as determined by the TheCanoeMan. We accept no responsibility for consequential loss or damage howsoever arising from the letting evidenced by this agreement unless it arises from our negligent act or default.

We occasionally take photographs which may be used in future articles or advertising material.

If you DO NOT wish to photographed, please tick the box.

Please note if you are signing this form on behalf of a group which you are organising, you are confirming that all members of your party have fully read and understood the terms and conditions attached to this booking and that they are happy for you to sign on their behalf and that you have disclosed all relevant information relating to the individuals in your party (in particular health questions). If acting on behalf of a group who are booking a self guided trip we ask you to consider whether your group / club or you as the organiser has any liability in the event of an accident or fatality - if so you may wish to consider allowing us to provide you with a guide / instructor at which point the liability becomes ours.

I have had brought to my attention the Terms & Conditions relating to this booking, in particular, those concerning cancellation.

I understand that booking is accepted on the understanding that Activ-8 Adventure/ TheCanoeMan/ Norfolk Broads Tourist Information and Activity Centre, safety regulations are observed.

I accept that Activ-8 Adventure/ TheCanoeMan/ Norfolk Broads Tourist Information and Activity Centre, is not under any liability whatsoever in respect of loss or damage to personal property, not caused by negligence or default of Activ-8 Adventure/ TheCanoeMan/ Norfolk Broads Tourist Information and Activity Centre, its suppliers and its agents whilst attending the course.Print Name:

Signature:

Date:

(Parent or Guardian to sign if under 18)

Any further questions do not hesitate to contact us on: 0845 4969177Or email: info@TheCanoeMan.com