2018 Jimmy Webb Youth Sailing Scholarship Form
Email address *
Student's Name *
Your answer
Student's Nickname, if any
Your answer
Student's Sailing Experience, if any? *
Age *
Your answer
Birthdate *
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DD
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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
Family Income Level *
Describe Why the Student Would Benefit From Receiving a Jimmy Webb Youth Sailing Scholarship? *
Your answer
Has the Student Previously Received a Scholarship from the JPYC Foundation or a Jimmy Webb Youth Sailing Scholarship? *
Has the Student Previously Participated in the JPYC Foundation's At-Risk Youth Sailing Program? *
Did the Student Participate in the 2017 America's Cup Endeavor Program? *
Parent's/Guardian's Name *
Your answer
Summer Mailing Address *
Your answer
Winter Mailing Address, if different *
Your answer
Work Phone Number *
Your answer
Cell Phone Number *
Your answer
Home Phone Number *
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
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. *
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A copy of your responses will be emailed to the address you provided.
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