ROC City Sailing Class On-Line Registration Form

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.

Email address *

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

Mailing Address *

Phone Number *

Emergency Contact Name, Phone Number and relationship to Participant *

Does the Participant have any medical or other restrictions ROC City Sailing Instructors need to be aware of? *

YES

If YES, please describe below.

What class(es) are you registering for? *

YOUTH BEGINNER WEEK 1-AM, June 29-July 3, 8:30 am to noon [$200 per student]

YOUTH BEGINNER WEEK 1-PM, June 29-July 3, 1-4:30 pm [$200 per student]

INTERMEDIATE WEEK 2-AM, July 6-10, 8:30 am to noon [$200 per student]

INTERMEDIATE WEEK 2-PM, July 6-10, 1-4:30 pm [$200 per student]

YOUTH BEGINNER WEEK 3-AM, July 13-17, 8:30 am to noon [$200 per student]

ADULT BEGINNER WEEK 3-PM, July 13-17, 1-4:30 pm [$200 per student]

INTERMEDIATE WEEK 4-AM, July 20-24, 8:30 am to noon [$200 per student]

BRIDGE TO RACING WEEK 4-PM, July 20-24, 1-4:30 pm [$200 per student]

Private or Semi Private Lessons

Required

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 (go to the RCS registration page for a copy of the form) *