Private sailing lessons Enrolment/Medical form

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This form needs to be filled out by the parent or legal guardian of the person wishing to participate in the sailing program.

Name of Student *

Age of Student

Do you consent to us having your mobile number? If so, please provide this.

Desired course (2 - 2.5 hr. lessons)

Juniors and Youth (16 yrs or under R400 (Members) / R500 (Non-Members).

Adult individual R500 (Members) / R600 (Non Members)

Clear selection

Are you (or your parents) a club member

Yes

Clear selection

Do you have your own life jacket

Yes

Clear selection

Do you have your own wet suit

Yes

Clear selection

Are you a competent swimmer

Yes

Clear selection

Name of Person to contact in emergency *

Email address of participant

Medical and Emergency

Contact number in case of an emergency
*

Name of second contact person in the case of an emergency *

Number of 2nd contact person *

Does the family have medical aid? *

Yes

No (If no please write NONE in below required fields)

Name of Medical aid *

Medical aid membership number *

Main members ID number *

Participants medical condition disclosure

My child does not have any medical condition

My child has a medical condition

My Child has a medical condition that requires the administration of chronic medication

I don't have any medical conditions

I do have a medical condition

I have a medical condition that requires the administration of chronic medication

Other:

Clear selection

Brief description of medical condition and actions required to assist

Please disclose any medical condition that you or your child has that could put you/him or her at risk while participating in the sailing course

Liability and Waiver

“In granting this permission I hereby irrevocably indemnify Knysna Yacht Club, its representatives, officials and staff against any claim and liability of any nature whatsoever and howsoever arising whether directly or indirectly, whether from negligence albeit gross and/or from involvement in any activity whilst participating in the sail trading including but not limited to liability for accident, death, injury, illness to their person or loss or damage to property or costs and expenses sustained or incurred as a result thereof”.

I agree

I am aware that I am liable for any medical or other expenses that may result from any injury or occurrence. In the event that I cannot be reached, I give my permission to Knysna Yacht Club to administer and authorize any emergency medical treatment deemed necessary for the welfare of my self/ my son / my daughter.

(Please note that we will always attempt to contact the parents/emergency contact before we administer or authorize any emergency medical treatment. Please note that in the case of prescription medication we are only allowed to administer medication alongside a signed medical instruction note from the parents)

I agree

Media Consent

I have also ensured that I/my son/daughter is willing to participate in all aspects of the sailing course and permit Knysna Yacht Club to take photos and/or videos of me/my son/daughter while I/he/she is on course for compiling course reports, designing any physical and/or digital marketing material and for updating social media platforms such as Facebook, Twitter and Instagram. I accept that there will be no further recourse or royalties liable by the club for use of any such photos.

I agree

Clear selection

Payment and Commercial

I understand that there is a cost involved and agree to pay the following to Knysna Yacht club based on my selection of the course.

I agree

Clear selection

Please note that we require written notice to remove yourself, your child from the course and no refunds will be given

I understand

Clear selection

Payment

- Knysna Yacht Club, FNB,

Acc No 62288441464,

Branch 210214

NB: Use students Name and Surname (All payments must be made prior to the course commencement)

Payment at KYC office

EFT option (Please remember your reference information to ensure payment gets allocated correctly)

Clear selection

I am aware of the time slots and I will attend or "Drop off" and "Collect" my child timeously so as to not hold up the classes or the instructors.

I Agree and understand

Clear selection

Submit

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