LEARN TO SAIL STUDENT REGISTRATION

FEE PAID $250.00
Date
Applicant (applicant to complete):

Name Birth Date

Sex: Male Female

Address
No.       Street       City     State      Zip

Phone Home       Cell
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Parent/Guardian (parent/guardian to complete if applicant is a minor):

Father's Name

Phone Home      Cell

Mother’s Name

Phone Home      Cell

Email [confirmation]

Emergency Contact Name 

Phone Relation

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Course Information (applicant to complete):

You understand you are committed to complete six (6) lessons
each being three (3) hours on Saturdays between 9:00 am and 12:00 pm    Initials
within a ten (10) consecutive weeks.                                                                

Can you swim approximately 50 yards.using
any stroke, in sailing clothing and shoes/booties?    Yes     No   

Not Sure

Your previous sailing experience

What personal goals do you hope to achieve by taking this course?

I assume full responsibility for any loss or damage, excepting loss or damage covered by insurance, that may come to any person, boat, sailboard, equipment, pier, float, or other property used in conjunction with this course as the result of improper use, negligence, violation of the rules, and other acts of sailors, or other representatives of the school, instructional program or host location in connection herewith. I accept that the sport of sailing and the conduct of this course entail and are subject to certain inherent risks and assume all risks on land and on the water of participation in this program. I further agree to hold the school, instructional program or host location, US SAILING, and their representatives harmless for personal injuries and/or property damage.

Signature [please type in your full signature name]       Date
Applicant, or Parent/Guardian (if a minor)