2018WILLIAME. MEEYOUTH SAILINGPROGRAM APARTNERSHIP BETWEEN
TheMattapoisettCommunitySailing AssociationInc.
TheMattapoisettRecreation Department
508-758-6474
Mattsail.org
P.O.Box 947
Mattapoisett, MA
Student InformationName: Homephone:
Age:
Date of Birth: School: CurrentGrade:
Parent/Guardian Information Name: Home phone:
Address:
streetapt.#townstatezip
LocalAddress: LocalPhone:
Work/cell phone: Email Address:
Please check ifyou do notwantyourChild’sphoto included in any media coverage.
Emergency Pick-up Contacts
1.)
NAMERELATIONSHIPHOMEPHONEWORK/CELLPHONE
2.)
NAMERELATIONSHIPHOMEPHONEWORK/CELLPHONE
3.)
NAMERELATIONSHIPHOMEPHONEWORK/CELLPHONE
HEALTHMEDICAL INFORMATION
PLEASE ATTACH A COPY OF STUDENT’S LATEST IMMUNIZATION AND PHYSICAL EXAMINATION REPORT
Physicianname: Phone: MedicalInsurancetype: Policy#: Medications: Allergies: Explain: MEDICAL SERVICES CARE AND/OR TREATMENT AUTHORIZATION
Asaparentorlegalguardianoftheminorregistrant,I/weauthorizethe MCSAitsofficers,directors,agents,servants,
instructorsand employeestoobtainmedicalservices,careand/ortreatmentfor(student’s name)asshall reasonablyappearrequiredasaresultofan accidentand/orillnessthatmayariseduringhis/her
involvementand/orparticipationin the MCSA,WilliamE.MeeYouth SailingProgram.Priortoobtainingor
attemptingtoobtaineachsuchservices,and/ortreatment,reasonableeffortsshallbe madetocontactthepersonslistedas emergencycontacts.
Parent/GuardianSignatureParent/GuardianPrintNameDate
PROGRAM OUTLINE
Student Ages: The SummerSailing Program isopentoall studentsages6 to 13 forAMclasses, & ages8to 17forPMclasses. Studentsages6-8 will be assigned to theJuniormorningprogram.
ProgramTuition:The costofeach two-week programis$300 perstudent. No class on July 4th Session 1 cost $270.Tuition Assistance is available. No Refunds.
Lunch Program:If you are looking for a full day option the sailors can pack their lunch, eat with our sailing instructors, and be walked to Center School for Seahorse Explorers Program... The cost of this program is $330.00 for the two week session. Parents must register for Afternoon Seahorse Explorers Program separately and sign a release form. Additional cost of Seahorse Explorers Program is required. . Please contact them at Mattapoitsett Recreation.@
Note:Studentsmustpassabasic swimmingtestonthefirstdayofclass.
MorningProgram-8:30AMto11:30 AM: Sessions1,2,3: Themorning programsare designedforbeginner sailorswith little orno sailing experience or forsailorswho need to build confidence intheirsailing ability. The morning programsare designed to teach basicsailing nomenclature, safety rules,and willconsistofdaily shore lessonsand onthe waterinstruction.
AfternoonProgram-12:30PMto3:30PM: Sessions1,2,3: Studentsin the afternoon programsmusthave some sailing experience, knowledge ofbasic sailing nomenclature andsafety rulesalong with confidence to crew orskipper.
RaceSkillsProgram-12:30PMto3:30PM:Session 2 and3: Thisafternoonprogram isdesigned toteach the experienced sailors racing rules, safety,skills,and strategiesaswell asto foster team work betweenskippercrew. Notethe availability of the
raceskillsprogramwill depend uponsufficientinterestedenrolment;otherwise itwillbe replaced by aregularafternoonprogram.
SELECTION: Circle the Session andTime (AMorPM)foryour1st, 2nd, or3rd choice. Returnby May15th forbestselection. Applicationswillbe considered in the orderthey are received. Applicationswill be accepted until thefirstday of class.
DATES:1STCHOICE:2NDCHOICE3RDCHOICE
Session 1 / July 2nd toJuly 13th, 20188 / AM / or / PM / AM / or / PM / AM / or / PM
Session 2 / July 16thtoJuly 27th, 2018 / AM / or / PM / AM / or / PM / AM / or / PM
Session 3 / July 30thtoAugust10th, 2018 / AM / or / PM / AM / or / PM / AM / or / PM SEAL OR SHARK
STUDENT EXPERIENCE: / 1. Never sailed / 2.Didsomesailing onsomeone else'sboat
3. Tooksailing atcamp / 4. TookMCSA Program. / 5. Have sailed at the helmofaboat
RELEASE AND INDEMNITY AGREEMENT
Forvaluableconsiderationreceivedtheundersigned,herebyreleaseMCSAit’sofficers,directors,agents,servants,instructors andemployeesfromanyandallclaims,demands,actions,orcausesofactionwhichtheundersigned,ourheirs,personal repre- sentatives, agentsorassignshave ormay have orwhichmay arise outof _(student’s name)involvementand/orparticipation inthe MCSAWilliam E. Mee Youth Sailing Program, including butnotlimited to, direct actions,third-partyactions, claims,cross-claims,demandsoractionsforcontributionorindemnification. Moreover,unless
indicatedabove, the undersigned hereby approvesofphotosto be taken of theirchild foruse inMCSA promotionalmaterials.
Parent/GuardianSignatureParent/GuardianPrintNameDate
COMPLETETHISSECTIONONLYIFYOUAREAPPLYINGFORTUITION ASSISTANCE.
Limited tuition assistance is available through theKARLM.COLLYERMEMORIALFUNDtobe distributed annually primar- ily on afinancial need basis.Ifyourchild participatesineither the (please complete)Free orReduced SchoolLunch Program, please provide a copy ofyour school lunch application with thisapplication. Ifyourchild doesnotqualify foreither school lunch program, please submitabriefstatementon aseparate sheetofpaperwith an explanation ofyourparticular financial hardship and thebasisforyour requestfortuition assistance. Such statementswill be presentedto theMCSA Board of Directors
forconsideration inthe order thatthey are received.
APPLICATION CHECKLIST
Completed registration application
Signed MEDICALTREATMENTAUTHORIZATION & RELEASE ANDINDEMNITYSECTIONS
Included copiesofstudent’slatestimmunization andphysical examination report
Included paymentorTuition Assistance information.
MAIL / MattapoisettCommunitySailingAssociationInc. / 508-758-6474APPLICATION / Attn.Student Application / mattsail.org
TO: / P.O.Box947
Mattapoisett,MA02739Mattsailmember YES / NO / Membernumber