Pistakee Yacht Club Sailing School
Registration 2012
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Student's Name___________________________________Age_______
Parent/Guardian Name________________________________________
Street Address______________________________________________

Daytime Phone _____________________________________________

Cell Phone_________________________________________________
Email Address______________________________________________
Emergency Contact Name and Number___________________________
Any Allergies?______________________________________________
Medications?_______________________________________________
Session or Dates Requested____________________________________
Fee Submitted______________________________________________
Interested in Social Membership?________________________________
  In understand that there are risks involved in the sport of sailing and assume full risk of injuries, damages or loss which I or my minor child may sustain as a result of participating in this sailing program.

 
Parent/Legal Guardian Signature_________________________________
Print Name_________________________________________________
Date___________________________________

For More information Email Us or call 847-587-4445

After printing and completing this form, mail to:
Catherine Boettcher
P.O. Box 307
Ingleside, IL 60041
Make Checks Payable to PYC Sailing School
Pistakee Yacht Club Sailing School admits the students of any race to all the rights, privileges, programs and activities generally accorded or made available to students at that Pistakee Yacht Club Sailing School does not discriminate on the basis of race in administering it?s educational policies, admission policies, scholarship and loan programs, and athletic and other school-administered programs. We do not discriminate on the basis of color or national or ethnic origin.

All students must be escorted to the yacht club and not dropped off in the parking lot or on the pier. Student must be handed off to an instructor.
Pistakee Yact Club
3300 N. Rocky Beach Road, Johnsburg, IL 60050
815-385-9871
Mailing Address: P.O. Box 111 McHenry, IL 60050
info@sailpistakee.com • www.sailpistakee.com