Shorebased Course Booking form

Name

First

Last

Address

Postcode

Phone Number

Date of birth

DD/MM/YYYY

Email

Qualifications Name to

Emergency Contact

First

Last

Emergency Contact relationship to student

Emergency Contact Phone Number

Course booking

Course date if known

DD/MM/YYYY

Previous Qualifications – Shorebased 1 Day/Online Course's

Previous Qualifications – Shorebased Navigational Course's

Previous Qualifications – Practical Course's

Other relevant maritime qualifications or experience not listed above?

Please include dates inc expiry. If none type “None”.

Health details

Any underlying health conditions that the instructor should know about? If none type “None”

Special educational needs

If none type “None”

GDPR and Terms & Conditions

By submitting this form, you agree to the processing of your personal data in accordance with our Privacy Policy. We will use the information you provide solely to respond to your enquiry and to provide any requested services. Your personal data (such as name, email address, phone number, and message) will be processed lawfully, fairly, and transparently. We will not share your details with third parties without your consent, unless required by law. Your data will be stored securely and only retained for as long as necessary to fulfil the purpose of your enquiry. You have the right to access, rectify, or erase your personal data, restrict processing, and object to processing at any time. To exercise your rights, please contact us at Info@Marine-Pro-Academy.co.uk
By submitting this form you agree to Marine Pro Academy Ltd Terms & Conditions which can be found at www.Marine-Pro-Academy.co.uk/Terms-And-Conditions

Marine Pro Academy Ltd