Haven Banks Outdoor Education Centre - Haven Banks

Account Registration Form
This form is used to create accounts for adult and student participants.

Information

Please note that an account is required for each adult or child who will be participating in an activity.

Email Address^*

This will be your username and will be required when you log in to Wisepay.

Confirm Email Address^*

Please confirm your email address to ensure it has been entered correctly.

Password

##########

WisePay will automatically generate a strong password when this form is submitted. You will be sent an email to the email address entered above containing your log in credentials.

Password

WisePay will automatically generate a password when this form is submitted. You will be sent an email to the email address entered above containing your log in credentials.

Participant Details

Please enter the name of the Adult / Child that will be attending the courses purchased.

Daytime Phone Number^*

Please enter a daytime telephone number that we can use should we need to make contact with this participant

Mobile Phone Number^*

Please enter a mobile phone number that we can use should we need to make contact with this participant

Evening Phone Number

Please enter an evening telephone number that we can use should we need to make contact with this participant

Participant Medical Details / Consent

Please complete the sections below. Please note that this information will be stored on WisePay against your account details.

Diabetes

The participant does NOT suffer from Diabetes
The Participant DOES suffer from Diabetes

Asthma

The participant does NOT suffer from Asthma
The participant DOES suffer from Asthma

Epilepsy

The participant does NOT suffer from Epilepsy
The participant DOES suffer from Epilepsy

Other Medical Conditions

There are NO other medical conditions
YES there are other medical conditions

Are there any other medical conditions of which the centre should be aware ?

If Yes - Other Medical Conditions

If you selected Yes to the question above, please provide details.

Any Recent Illness

There have been NO recent ilnesses
YES there has been a recent illness

Are there any recent illnesses of which the centre should be aware ?

If Yes - Any Recent Illness

If you selected Yes to the question above, please provide details.

50 Metre Swim

YES the participant can swim 50 metres
NO the participant cannot swim 50 metres

Is the participant able to swim 50 metres ?

Water Confident

YES the participant is water confident
NO the participant is not water confident

Is the participant water confident with regard to the proposed activity ?

Photo Consent

YES I do consent for you to use my photograph
NO I do not consent for you to use my photograph

Parantal Consent (if applicable)

Not Applicable
YES I do provide authority for parental consent
NO I do not provide authority for parental consent

If you are registering for a child do you provide authority to give parental consent ?

Guardian / Next of Kin

Please provide Guardian details if you are registering a child, or next of kin details if you are registering an adult.

Daytime Phone Number^*

Please enter a daytime telephone number that we can use should we need to make contact with the guardian / next of kin.

Mobile Phone Number

Please enter a mobile phone number that we can use should we need to make contact with the guardian / next of kin.

Evening Phone Number

Please enter an evening telephone number that we can use should we need to make contact with the guardian / next of kin.

This challenge is to prevent automated systems from using this feature maliciously.
Load New Code

Creating Multiple Accounts (For example, family members)

If you wish to create another account, perhaps for a second or third child, then please press the "Save and Create Another Account" button below.

Protection of Personal Data and GDPR legislation

Haven Banks Outdoor Education Centre may ask you to provide personal data on this form. This data is stored by WisePay on behalf of Haven Banks Outdoor Education Centre, to meet the legal obligations of a contract between WisePay and Haven Banks Outdoor Education Centre. You are required to give your consent that this data can be processed by Haven Banks Outdoor Education Centre.

Your Consent

I consent that this data can be processed by Haven Banks Outdoor Education Centre.

Welcome to our Online Payment Area

Welcome to our Online Payment Area