Orion Training

 

Course Application Form

 

 

Date of Application …………/………/………….                 Insert passport size photograph κ

Course                                                 4

Medical First Aid Aboard Ship

 

 

Medical Care Aboard Ship

 

 

Elementary First Aid

 

 

Offshore First Aid (stcw95) MODU

 

 

HSE Offshore First Aid

 

 

Appointed Person

 

 

Mountain First Aid

 

 

Expedition Medicine

 

 

Laryngeal Mask Airway   (LMA)

 

 

Automated External Defibrillator (AED)

 

 

Oxygen Therapy as an adjunct to CPR

 

 

Entonox

 

 

BBC - 999 Assessment

 

    

 

 

Course date if known……………………………………………………../….…/……...

 

Please complete forms clearly as the information given will be used for any certification /accreditation

 

Title

First Names

Surname

Nationality

Occupation

Mr

 

 

 

 

 

Mrs

 

 

 

 

 

Miss

 

 

 

 

 

Ms

 

 

 

 

 

 

 

Home Address

 

Emergency contact    

Address

 

Add1

 

 

 

 

Add2

 

 

 

 

Add3

 

 

 

 

Town

 

 

 

 

County

 

 

 

 

Post Code

 

 

 

 

Country

 

 

 

 

 

Contact Tel Nos.

 

 

Work Tel No

 

Home

 

 

Home

 

Mobile

 

 

Mobile

 

Fax

 

 

Fax

 

e-mail

 

 

e-mail

 

 Radio Call sign

 

 

Radio Call sign

 

 

D.O.B.   (date of birth)

 

 

National Id

 

          __  __  /  __  __  /  __  __  /  __  __  /  __ 

Discharge No

(Maritime Courses only)

 

 

 

 

 

Cost of course if known.   £………………….. (contact office for quotation)

 

 

Terms of agreement.

 

Companies are required to contact Orion office for further details whereby a written quotation will be issued.

 

Individuals will be required to complete this form Apform 1.

 

The price quoted will be subject to  :-

 

 

1)                   10% deposit on application.

2)                   Full payment 28days prior to course commencement.

3)                   In the event of cancellation by Orion Training all monies paid will be refunded.

4)                   In the event of cancellation by delegate / company purchasing the course, 50% of the deposit will be repaid upto 28 days prior to the commencement of the course

5)                   Cancellation within 28 days of the commencement of the course no refund will be given.

 

6)                   Medical training outdoors on the fells, on board ship, oil rig etc.

 

While Orion Training will endeavour to run the course to its maximum potential, certain conditions outside the Orion Training management control may effect the running of the course. i.e. weather conditions government policy & local council restrictions (foot & mouth access restrictions). The management reserves the right to alter the nature of the course in such a way as it deems fit.

 

7)                   It is the responsibility of the delegate to ensure he /she is properly equipped with personal protective equipment (PPE) for the medical courses held outdoors i.e. Expedition Medicine – items such as waterproofs, boots etc .A full list will be sent out prior to the course commencement.

 

8)                   It is the responsibility of all delegates to be mindful of all health and safety aspects medical or otherwise, to ensure the safety of others. Delegates who do not observe these conditions will be removed from the course and no refund given.

 

 

 

 

 

I agree to the above conditions outlined by the management of Orion Training.

 

 

 

Signature of applicant       …………………………………………………………………………………..Dated………../………/………..