PYC Jr. Sailing 2019 Registration Form
2019 Class Schedule:
Week 1 July 08 - 12 Learn to sail
Week 2 July 15 - 19 Learn to sail
Week 3 July 22 - 26 Learn to sail
Week 4 July 29 – Aug 02 Double-handed Sailing
Week 5 August 05 - 09 Learn to sail
Week 6 August 12 - 16 Adventure Sailing
The registration fees for 2019 are:
One Week Class: $225.00
One Week Class (PYC members): $205.00.
One Week Class (2nd student or more from same family, same week): $205
One Week Class (Active Duty Military): $195.00
PYC Junior Sailing Program
Primary Contact's First Name *
Your answer
Primary Contact's Last Name *
Your answer
Primary Contact's Relationship to Student *
Primary Contact's Email *
Your answer
Primary Contact's Phone *
Your answer
Secondary Contact's First Name
Your answer
Secondary Contact's Last Name
Your answer
Secondary Contact's Relationship to Student
Secondary Contact's Email
Your answer
Secondary Contact's Phone
Your answer
Home Phone
Your answer
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
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Can the student swim at least 50 ft.? *
Can the student swim 50 feet in salt water while wearing a PFD?
Student's sailing experience? *
What prior sailing experience does the student have?
Your answer
May we publish photos of your child online? *
Primary Contact's Street Address *
Your answer
Primary Contact's City, State, Zip *
Your answer
Which week are you registering for? *
Required
Student's Allergies to food, drugs or insects
Your answer
Student's Date of last Tetanus Shot
Your answer
Student's Blood Type (If you know for sure)
Your answer
Medications student takes regularly:
Your answer
Additional Emergency Contact Info. *
Additional Emergency Contact Info (Name, phone, Family Physician's name, etc)
Your answer
Fees (check fee which applies): *
Required
Optional Fees (check desired items):
Would you like receive PYC Jr. Sailing course offerings by email?
How did you learn of our program?
Physical limitations or chronic ailments*? If yes, please describe:
Does the student have any physical limitations or chronic ailments that might limit full participation in the program*? If yes, please describe:
Your answer
Conditions or concerns staff should know*? If yes, please describe:
Are there any conditions or concerns with which program staff should be familiar*? If yes, please describe:
Your answer
I agree to complete and mail 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. Access forms from here: https://poulsboyachtclub.org/page/junior-sailing-program#RegistrationForms
Required
*I understand the Safety & Payment statement below: *
*We will take every precaution to keep students safe, but kids will be kids, and we need to be prepared. 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.
Required
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