2021 SHYC JR: Medical, Emergency Contact, Permission to Treat, Contact Info
Please complete this form to authorize emergency treatment for your child for the SHYC Junior Programs.
Email *
Participants/Child Name *
Date of Birth *
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DD
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Street Address *
City *
State *
ZIP *
Alternative Email *
Gender *
FOR SAILING PROGRAM PARTICIPANTS ONLY: Check the "YES" box below to authorize SHYC to provide your child's contact information (name, DOB, gender, parent email, parent cell, mailing address) to US SAILING to create a JR US SAILING Membership and Skill-UP account for your child to use as part of the Sailing Program at SHYC. Learn more at: https://www.ussailing.org/membership/organizations/skill-up/ *
Required
Height (inches) *
Weight (lbs) *
US SAILING: If you have a Family US SAILING Membership or your child is a Youth Member of US Sailing, indicate US Sailing Member # here. If you don't know, or are not a USS member, skip this question.
Please list any current or past medical problems: *
Surgical History: *
List all Allergies (Medication, Foods, Bees, Wasps, Jelly Fish, or more): *
Current Medication Taken: *
Date of last Tetanus shot: *
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