A. Participant Information

Name Are you fluent in English?

Home Phone Cell Phone Email

Birth Date (m/d/y) I identify my gender as

School Shoe Size, Height, & Weight

B. Parent/Guardian Information

Name Email

Home Phone Cell Phone Work Phone

C. Consent for Photographs

I consent to the Nova ScotiaSeaSchool using all photographs and video and audio recordings in which I appear, while enrolled as a student in one of their programs, for the purpose of promoting the School or for related purposes.

D. Acknowledgment of Risk and Assumption of Personal Responsibility

I understand that a Nova Scotia Sea School Seamanship Course is a wilderness adventure program. I understand that during the course I will be living in an open boat and navigating the ocean coast sometimes more than a kilometer from land. I understand that during my participation in a Nova ScotiaSeaSchool course I will, at times, be exposed to above-normal risks.

I understand that the Nova ScotiaSeaSchool has taken precautions to provide proper equipment and well-qualified instructors for each course. Nevertheless, I realize it is impossible for the Nova ScotiaSeaSchool to guarantee absolute safety. I understand that I share responsibility for acting safely on this course and I assume that responsibility.

I confirm that I have verified that I have no physical or psychological problems or conditions that would prohibit my participation in the course. I agree to comply with the instructions and directions of all Nova ScotiaSeaSchool staff members during the course. I agree to refrain from using alcohol or non-medically-prescribed drugs while on course, and I have also read and agree to all the Nova Scotia Sea School policies presented in the listed above.

In particular, I confirm that I have carefully read the list of “What To Bring On ADay Sail” in the Nova Scotia Sea School Enrollment Package, and I understand that any failure on my part to bring the proper clothing as listed will endanger my safety and may result in my being prohibited from participating in the course.

My signature below indicates a genuine intent to participate fully in all aspects of the course in a manner which challenges me, is helpful to others and protects the environment.

I understand that a Nova ScotiaSeaSchool course is a physically demanding and mentally challenging program. I agree to respect the safety regulations of the program as communicated by my instructors.

2057 Gottingen St, Halifax, NSB3K 3B2 • (902) 423-7284 • Fax: (902)423-7241

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