CPYC Youth Sailing Agreement & Registration Form

CPYC Youth Sailing Agreement & Registration Form

(One Application Per Child)

Please enroll my son/daughter in the Cottage Park Yacht Club Sailing Program.

Sailor’s Name:______Phone:______

Address:______Cell: ______

Email Address(es): ______

Date of birth:______( Child must be 8 by 6/30/12 to participate)

Grade entering September 2012: ______

Parent/guardian’s name (CPYC member):______

I am currently a member in good standing _____ I have a membership application pending:____

Emergency Contact and Phone #: ______

Health insurance name and Policy: ______

If your child has any health concerns we should be aware of please explain: ______

Boat information:

Do you own an N-10/Turnabout, Laser, Opti, 420 or other boat? ______

If yes, what is your boat name and sail #? ______

Would you be willing to loan your boat to other students in classes? ______

If you do not own a boat have you made arrangements for your child to sail with anyone? _____

If so, please identify here: ______

Locker number and combination: ______

Class Registration (check one): N10/Turnabout_____ Laser/420 _____ Opti _____

What is your child’s experience level? (check the most appropriate category):

___ Has never been in a sailboat

___ Has sailed with me but never alone

___ Can rig an N-10 by him/herself, but has never steered an N-10

___ Is comfortable steering an N-10 with supervision but not alone

___ Is comfortable steering an N-10 by himself or herself

___ Is comfortable steering an N-10 by himself or herself but does not want to race

___ Is an experienced racer and has skippered in regattas

In consideration of my child’s application being accepted to enroll in the supervised Youth Sailing program to be conducted under the auspices of the Cottage Park Yacht Club and the CPYC Youth Sailing Program, I hereby agree to hold the Cottage Park Yacht Club, its agents and employees, the CPYC Youth Sailing Program and its officers and sailing instructors harmless and forever indemnified against any and all claims, actions, damages or injury sustained to my child or to my child’s boat, its equipment and contents during the conduct of the said sailing program.

I also agree to provide and have my child wear a U.S. Coast Guard approved personal flotation device at all times in a boat and on the pier and docks.

PARENT/GUARDIAN’S SIGNATURE: ______
Date:______

Below to be filled out by Treasurer:

Tuition Deposit $50______User Fee $100 ______Tuition Payment : $______