ROC City Sailing On-Line Registration Form

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ROC City Sailing Inc.
2050 Bay Shore Boulevard, Rochester NY 14622
Contact us at (585) 210-3225 or info@roccitysailing.org

Please complete and submit one form per participant. Roc City Sailing will follow up to make final arrangements.

Email *

First Name of Participant *

Last Name of Participant *

Birth Date of Participant *

YYYY

Name of Parent / Guardian if Participant is under 18 years of age

Home Mailing Address *

Phone Number *

Emergency Contact Name, Phone Number and relationship to Participant *

Is the Participant an age 8 to 17 student of a Rochester City District School? *

Yes

What is the participant's level of sailing experience? *

Beginner

Intermediate

Advanced

What is the participant's level of swimming experience? *

Can swim comfortably in deep water

Can swim comfortably in deep water with a Life Jacket

Not comfortable in the water

Never been in the water

What class(es) are you registering for? *

YOUTH BEGINNER AM CLASS 8:30 to noon, Jun 27 to Jul 1, 2022 [$200 per person]

YOUTH BEGINNER PM CLASS 1 to 4:30, Jun 27 to Jul 1, 2022 [$200 per person]

INTERMEDIATE AM CLASS 8:30 to noon, Jul 5 to 8, 2022 [$150 per person]

FAMILY ANY LEVEL PM CLASS (BEGINNERS, INTERMEDIATE) 1 to 4:30, Jul 5 to 8, 2022 [$150 per person]

YOUTH BEGINNER AM CLASS 8:30 to noon, Jul 11 to 15, 2022 [$200 per person]

ADULT BEGINNER PM CLASS 1 to 4:30 Jul 11 to 15 2022 [$200 per person]

YOUTH BEGINNER AM CLASS 8:30 to noon, Jul 18 to 22, 2022 [$200 per person]

MIXED ANY LEVEL (BEGINNERS, INTERMEDIATE) 1 to 4:30, Jul 18 to 22, 2022 [$200 per person]

SMALL GROUP ADVENTURE SAIL [$50 per person for 2 hour sail ... min 4, max 6 people]

PRIVATE or SEMI-PRIVATE (2 people) Lessons [$100 per 2 hour lesson]

GIFT CERTIFICATE for a 2022 Small Group Adventure Sail [$50 per person]

GIFT CERTIFICATE for 2022 1/2 day, one week class [$200 per person]

GIFT CERTIFICATE for a 2022 private or semi-private lesson [$100 per lesson]

Rochester City School District URBAN YOUTH ADVENTURE SAIL [Sat July 30, 1 to 4pm]

Rochester City School District URBAN YOUTH ADVENTURE SAIL [Sat Aug 6, 1 to 4pm]

Rochester City School District URBAN YOUTH ADVENTURE SAIL [Sat Aug 13, 1 to 4pm]

Rochester City School District URBAN YOUTH ADVENTURE SAIL [Sat Aug 20, 1 to 4pm]

Required

If you are purchasing a GIFT CERTIFICATE what name(s) do you want on the certificate?

LIABILITY WAIVER: In consideration of being allowed to participate in the Roc City Sailing (RCS) activities, events, and services, I, the undersigned, acknowledge, appreciate, and agree via the checkboxes below that: *

RULES & REGULATIONS: I hereby agree to abide by the rules, regulations, and policies of the RCS Organization, including any and all health and related safety measures required by the Organization.

ACKNOWLEDGMENT & ASSUMPTION OF RISK: I assume full responsibility for my participation in RCS activities and I agree to assume all risks, known and unknown inherent in RCS activities.

RELEASE & INDEMNITY: I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release, indemnify, and hold harmless Roc City Sailing, their employees, other participants and members, sponsors, advertisers, and if applicable, owners and lessors of the premises used for activity (“Releasees”), with respect to any and all injury, disability, death, or loss or damage to person or property associated with presence or participation to the fullest extent permitted by law.

UNDERSTANDING & AGREEMENT: I have read this release of liability, assumption of risk agreement, fully understand its terms, and understand that I have given up substantial rights by submitting it, and submit freely and voluntarily without any inducement.

Required

PHOTO / VIDEO RELEASE *

I agree to let any photos/video taken of me during Roc City Sailing classes to be posted on Roc City Sailing's website or used in promotional or advertising materials.

I do not agree to let any photos/video taken of me during Roc City Sailing classes to be posted on Roc City Sailing's website or used in promotional or advertising materials.

HEALTH AND SAFETY PRE-SCREENING FORM [use this link for a copy of the form] ... https://roccitysailing.org/wp-content/uploads/2021/04/RCS_Health-Safety_Pre-ScreeningForm_2apr2021.pdf *

I have reviewed, understand and agree to use the RCS Health and Safety Pre-Screening form before participating in RCS lessons and activities.

Please confirm which method you used to complete payment [please go to the RCS Website "Pay for Lessons" page to complete payment] ... https://roccitysailing.org/pay-for-lessons/ *

Yes, I have submitted payment on-line via credit card or PayPal account

Yes, I have written and mailed a check

I am requesting a Rochester City School Student Scholarship

How did you find out about ROC City Sailing? *

Internet search

Facebook

RCS hardcopy Flyer

Kids out and about Website

Kids Out and About Newsletter

A friend

School info on summer camps

City of Rochester Communication

Other:

Any comments or questions you want to add?

A copy of your responses will be emailed to the address you provided.

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