Bremerton Yacht Club
Youth Sailing Program
2700 Yacht Haven Way
Bremerton WA 98312

Address ___________________________________________________________________

City, State, Zip ____________________________________________________________________

Father's Name ________________________________ Mother's Name _________________________________

Home Phone (_____)__________________________ Home Phone (_____) _______________________

Work Phone (_____)__________________________ Work Phone (_____)________________________

Can the student complete our swim test? (Swim 50 feet in salt water while wearing a PFD) Yes

What prior sailing experience does the student have? _________________________________________________

Course Preference: June 28-July 2 - - July 5-9 - - July 12 - July 16 - - July19-23 - - July 26-30 - - Aug 2-6

Please mark your preferred course(s) with an "X." If alternate dates will work, mark them with an "A." Early registrations will have priority, but we will try to accommodate as many as possible. If a conflict arises, we will call to discuss solutions.

Course Pricing: $175.00 per student. Price includes 30 hours of sailing instruction, participation tee shirt, prizes and awards. Please pay by check made payable to BYC Youth Sailing. Include your check with the completed registration forms.

How did you learn about the BYC Youth Sailing Program? _______________________________________________

Father Mother Other Person: Name ___________________________ Relationship __________

Phone (____)_____________ Work (____)______________

Other numbers to try (Cell Phone, Beeper, etc): (____)_____________ (____)______________

Family Physician Name _______________________________________ Phone (____)______________

Date of last Tetanus Shot __________________ Blood Type (If you know for sure) ___________________

Allergies to food, drugs or insects _________________________________________________________________

Medications taken regularly ______________________________________________________________________

Does the student have any physical limitations or chronic ailments that might limit full participation in the Program?

Yes No If yes, please describe_________________________________________________________

Are there any conditions or concerns with which Program Staff should be familiar? Yes No

If yes, please describe __________________________________________________________________________

*We will take every precaution to keep students safe, but kids will be kids, and we need to be prepared. We will find a way to accommodate students who have special needs, but will need guidance from parents.

1. I am familiar with the Program offered and the starting and ending times of each day's session. I understand that officers and employees of the Club are available to discuss the program if I should wish additional information. I understand that I am solely responsible for the arrival and departure of my Child at the beginning and end of each day's session. I will not allow my Child to remain on Club premises after the day's session without appropriate supervision or the written permission of the Club. I agree that the Club will have no responsibility for the supervision of my Child at times other than during scheduled sessions. I understand the importance of regular attendance as each day builds on the prior day's learning.
2. I will inform my Child that he/she is expected to cooperate with and follow the directions of the instructors in charge of the program, to act in a manner consistent with the spirit of good sportsmanship, and to respect the rights of others.
3. I certify that my Child is in good health and I know of no reason why he/she would be incapable of participating in the Program. My Child knows how to swim. I will immediately notify the Club if there is a change in my Child's ability to participate in the Program.

4. WAIVER OF LIABILITY: I waive and release any right I, my heirs, distributees, guardians, legal representatives and assigns may have or acquire to make a claim against, sue, attach the property of or prosecute the Club or any of its members, directors, officers, agents, employees and affiliated organizations (herein referred to as "the releasees") for monetary damages caused by injury to my Child or damage to the property of my Child or myself arising from my Child's participation in the Program and use of the facilities and property of the Club, whether or not the injury or damage results from the negligence or other action, except intentional acts, of any of the releasees. (Please initial to indicate you have read this paragraph. _______/_______)

5. ASSUMPTION OF RISK: I am aware that the Program may involve maneuvering a boat on cold, deep waters in potentially hazardous conditions. These hazardous conditions may include, among other things, strong winds and high waves, sudden and unexpected immersion in cold, deep water and collision with other watercraft or stationary objects such as docks, pilings and buoys. With knowledge of the dangers involved, I voluntarily ask that my Child be allowed to take part in the Program. I ACCEPT ANY AND ALL RISKS TO MYSELF AND MY CHILD OF INJURY OR DEATH, AND PROPERTY DAMAGE ARISING FROM PARTICIPATION IN THE PROGRAM AND THE USE OF THE FACILITIES AND PROPERTY OF THE CLUB, WHETHER OR NOT CAUSED BY THE NEGLIGENCE OR OTHER ACTION, EXCEPT INTENTIONAL ACTS, OF ANY OF THE RELEASEES. (Please initial to indicate that you have read this paragraph. _______/_______)

6. INDEMNITY AGREEMENT: I agree to indemnify and hold the releasees harmless from any loss, liability, damage or cost, including reasonable attorney's fees, that may incur due to my Child's participation in the Program and use of the property and facilities of the Club, whether or not such loss, liability, damage or cost results from the negligence or other action, except intentional acts, of any of the releasees. (Please initial to indicate you have read this paragraph. _______/_______)

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THE AGREEMENT INCLUDES A WAIVER OF LIABILITY, AN ASSUMPTION OF RISK AND AN AGREEMENT BY ME TO INDEMNIFY THE RELEASEES, AND I SIGN IT OF MY OWN FREE WILL.

Parent's Signature: ______________________________________________ Date: _______________________

Printed Name: ________________________________________________