PYC Jr. Sailing 2020 Registration Form
Please complete this online registration form below. (Note: If you are registering more than one child please complete the abbreviated registration form titled "Second or Subsequent Registration Form" for each child located on the previous page.)

When completed please download the:
1. Participant’s Statement of Understanding and Parent’s Consent Form, and
2. Waiver of Liability, Assumption of Risk and Indemnity Agreement.
The forms are available at:
Note: if you compete the registration form below it is not necessary to download and fill out the "2020 Registration Form".

When the above forms are completed, sign and email scanned forms to:

Or, mail signed forms to:
Poulsbo Yacht Club
Junior Sailing Program
18129 Fjord Drive N.E., Suite E
Poulsbo, Washington 98370

Call Patty Henderson at 360-447-8119 or Email to for additional assistance.
Student First Name *
Enter Student's First Name
Your answer
Student Last Name *
Enter Student's Last Name
Your answer
Date of Birth *
Enter Student's Date of Birth
Course Preference *
Please select the course week desired. Consult website for dates and types of courses.
Student Email
Enter Student's Email Address
Your answer
Weight *
Enter Student's weight.
Your answer
Swim 50 Feet *
Can the student swim at least 50 feet?
Student Sailing Experience *
What prior sailing experience does the student have?
Your answer
Allergies *
Enter Student's Allergies to food, drugs or insects. If none please enter "None", otherwise, please describe:
Your answer
Physical Limitations - Chronic Ailments * *
*Does the student have any physical limitations or chronic ailments that might limit full participation in the program? If no please enter "NA", otherwise, please describe:
Your answer
Conditions or Concerns *
Are there any conditions or concerns you have regarding the student which our program staff should be apprised? If no please enter "NA", otherwise, please describe:
Your answer
Emergency Information *
Enter Additional Emergency Contact Information such as Name & Phone of Family Physician or Other Person's Contact Information.
Your answer
Publish Student Photos *
May we publish photos of your child for promotional purposes on social medias (Facebook, etc.), flyers, publications and promotional materials?
Primary First Name *
Enter Primary Contact's First Name
Your answer
Primary Last Name *
Enter Primary Contact's Last Name
Your answer
Primary Relationship *
Enter Primary Contact's Relationship to Student
Email *
Enter Primary Contact's Email Address
Your answer
Primary Phone *
Enter Primary Contact's Phone
Your answer
Secondary First Name
Enter Secondary Contact's First Name
Your answer
Secondary Last Name
Enter Secondary Contact's Last Name
Your answer
Secondary Relationship
Enter Secondary Contact's Relationship to Student
Secondary Email
Enter Secondary Contact's Email
Your answer
Secondary Phone
Enter Secondary Contact's Phone
Your answer
Home Phone *
Your answer
Street Address *
Enter Primary Contact's Street Address
Your answer
City, State, Zip *
Enter Primary Contact's City, State, Zip
Your answer
Appropriate Fee *
Check the fee which applies. Payable before the beginning of desired course week.
Select desired number of textbook(s). Each textbook is $10.00.
Select desired number of T-Shirt(s). Each T-Shirt is $10.00.
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Email List *
Would you like to receive information about Junior Sailing courses offerings in the future by email? By answering Yes, I understand that I may receive emails regarding this event and other relevant information, and can opt out at any time.
Advertisements *
Please indicate the ways you learned about our Junior Sailing program?
Transmittal of Registration Forms *
I agree to complete and mail: 1. Participant’s Statement of Understanding and Parent’s Consent and 2. Waiver of Liability, Assumption of Risk and Indemnity Agreement. These forms are available at: Then mail the completed forms to: Poulsbo Yacht Club, Junior Sailing Program, 18129 Fjord Drive N.E., Suite E, Poulsbo, Washington 98370
Statement of Safety & Payment *
*By checking "Yes" below you understand that we will take every precaution to keep students safe, but kids will be kids, and that you will keep us apprised of conditions we need to know in order to be prepared for potential situations. We will find a way to accommodate students who have special needs but we will need guidance from parents. I understand also that registration fees are required before the course begins.
Data Collection *
I consent to the collection, storage, and use of my information by Poulsbo Yacht Club as described in the Privacy Policy located at:
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