Booking Form

Activity & Course Booking From

Activity & Course Booking Form

if you have already paid for your course using PayPal please do not complete this form, please click HERE to go to the appropriate form.

Please complete the booking form below for all activities for individual bookings only, one booking form per person per activity/course.

Please make sure you have read our Terms & Conditions before making any booking. Go there Now T&Cs

This form is only to be used if making a booking and paying by a credit or debit card. We accept the following card:

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If you would like to book a course by using a paper booking form, please download our booking form from here

>Booking Forms<

Thank you, and we hope to see you very soon.

* indicates required fields

*Select Age:

*Title:

*Participants Full Name:

*Age:

*Date of Birth:

*Address:

*Post Code:

Occupation:

*Email Address:

*Home Telephone:

Work Telephone:

Mobile Telephone:

*Dietary Requirements:

*Medical Conditions:

Past Experience:

MLT/RTA Number:

*Emergency Contact Name:

*Emergency Contact Full Address:

*Emergency Contact Telephone - Main:

*Emergency Contact Telephone - Mobile:

*Course Code 1:

*Course 1 Title:

*Course 1 Date:

*Course 1 Cost £:

*Course Code 2:

*Course 2 Title:

*Course 2 Date:

*Course 2 Cost £:

*A: Total Course Fee £:

*Do you require insurance?:

*Insurance Level:

*B: Insurance Fee £:

*Total A+B = £:

*I am Paying Now:

*Total Paying Now £:

*Outstanding Balance (If 0.00 put Nil):

*Card Type:

*Card Number:

Valid From (mm/yy):

*Valid To (mm/yy):

*Name Printed on Card:

*3 Digit Security Code:

Issue No (Switch/Solo Only):

*Amount To be Debited: £:

*I authorise you to debit my card:

I authorise SRA&E to Debi my Card

*Have you Read our Booking Terms & Conditions:

*Insert your Name:

*Confirm Booking:

I Confirm my booking

*Todays Date:

PLEASE READ BEFORE SUBMITTING THIS FORM

I have read and understood the terms and conditions relating to the booking, in particular those concerning cancellation. I understand that bookings are accepted on the understanding that SRA Ltd safety regulations are observed. I accept that SRA Ltd is not under any liability whatsoever in respect of loss or damage to personal property, not caused by negligent or default of SRA Ltd, its suppliers, its agents and employees whilst attending the course. I have had my attention drawn to the information on the insurance cover, terms and conditions.

Participation in adventurous activities entails some risk of injury. Southern Rock Adventures Limited are trained and appropriately qualified to run activity sessions and will at all times proceed in a manner to limit the risk of injury. However participants accept that accidents and injury may occur.

Please continue to complete the rest of the booking form and once completed please click the Submit button at the bottom of this form.

Thank You.

Please click on the submit button to confirm your booking and just leave the rest to us.

If we have any problems we will get in touch with you using the contact details that you have supplied above.

If your participant is under the age of 18 years the next page will give you a link to the Parental Consent Form wich must be completed

We accept PayPal Payments for all of our online bookings using any of the Credit/Debit Card listed below. All payments are 100% secure using 128bit Encryption.

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Company Reg No: 06721875 VAT No: GB 938 5325 00

Registered in England & Wales, Registered Office: 31-33 Penel Orlieu, Bridgwater, Somerset, England UK, TA6 3PF

All information contained on this web site is purely information only as can not be used as pure fact.

SRA are the sole holders of the copyrights.

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