short course application form

Please complete this form to apply for one of our short courses. You will receive an automatic email to say that we have safely received your form.

Once we have processed your application we will email again with further information. Please note that your place is not confirmed until we have sent a formal confirmation.

* Required

First Name:*

Last Name:*

Email:*

Mobile Phone Number*

Address 1*

Address 2

Town / City*

Post Code*

Region

Country*

Your Organisation (if any):

Which course dates would you prefer?

Dietary Requirements

Medical Conditions

Medication

Gender

Female
Male

Date of Birth

Notes

Next of Kin Name*

Next of Kin Phone Number*

Terms & Conditions

By ticking this box I confirm that I accept Natural Change Limited's Terms & Conditions and reiterate that:

I am physically and psychologically fit for the course I have chosen and I have disclosed any medical conditions that may effect my safety, or the safety of the group, or the group leader(s);
I appreciate that my course may be hazardous by its nature and I accept that a certain element of risk is inherent in outdoor activities;
I understand that if I choose not to take the safety advice given to me by the course leader(s), I am personally liable for the outcome;
I have taken out appropriate insurance relevant to the course I have chosen.

I accept*

short course application form

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