| Student's Name___________________________________Age_______ |
| Parent/Guardian Name________________________________________ |
| Street Address______________________________________________ |
| City, State and Zip___________________________________________ |
|
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___________________________________ |
