2018 Junior Sailing Program Registration Form
Email address *
2018 Junior Sailing Program Registration Form
Where did you hear about this program?
Did the Student Participate in the 2017 America's Cup Endeavor Program *
Student's Name *
Your answer
Student's Nickname, if any
Your answer
Student's Sailing Experience, if any? *
Age *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Grade in School This Coming Fall *
Your answer
School Student Will Attend this Coming Fall *
Your answer
Swimming Level *
Height *
Your answer
Weight *
Your answer
T-Shirt Size *
Parent's/Guardian's Name *
Your answer
Summer Mailing Address *
Your answer
Winter Mailing Address, if different *
Your answer
Home Phone *
Your answer
Work Phone *
Your answer
Cell Phone *
Your answer
Emergency Contact Person's Name (Other than Parent/Guardian) *
Your answer
Emergency Contact Phone Number (Other than Parent/Guardian) *
Your answer
Session *
Required
Cost *
I will pay
WAIVER AND RELEASE: I understand that there are inherent risks in operating boats and participating in water sports activities. I, on behalf of the student and my family, hereby fully release, forever discharge and indemnify JPYC, the JPYC Foundation, any and all race sponsors, and their respective officers, directors, employees, contractors, volunteers, instructors, members, agents and representatives, from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services, attorneys' fees, or otherwise which may arise out of or related to the student's participation in JPYC's and the JPYC Foundation's sailing programs (including, without limitation, participation in races/regattas, sailing lessons), use of JPYC's and/or JPYC Foundation's equipment (including, without limitation, sail and powerboats, kayaks, SUPs, bikes, trailers, vehicles, etc.) and facilities (including, without limitation, the JPYC clubhouse, icehouse, gin pole, etc.) which could result in personal injury, loss of life and damage or loss to property. *
Required
MEDIA RELEASE: I hereby give JPYC and the JPYC Foundation permission to use film, video tape and/or photographs of the above mentioned minor for lawful promotional or informational purposes.
A copy of your responses will be emailed to the address you provided.
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