High School Sailing Registration

Participant Information:

Participant Name:*

First Last

Are you an AYC Member?*

Yes
No

AYC Member Number:*

Date of Birth:*

High School

Please list the high school that you currently attend, will attend next year if you are in 8th grade, or are zoned for if you are currently in a private school or homeschooled.

School District

Please list the school district that you are zoned for.

Grade Level

Parent/Guardian Information:

Parent/Guardian Name:*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Home Phone:*

Cell Phone:*

Emergency Contact:*

First Last

Secondary contact to be used in the event the Primary Parent cannot be reached.

Phone:*

Medical Info & Release

Health Insurance Provider:*

Phone:*

Group Number:*

Policy Number:*

Allergies and/or Relevant Medical Conditions:

In the event of accident, injury or illness involving any child of mine (specifically including my child named above as “Participant”) or me or my spouse while in, on, or about the premises of the Austin Yacht Club or while participating in any activity sponsored by or under the auspices of Austin Yacht Club under circumstances where I am physically unable to consent or am not present, 1. I hereby voluntarily authorize and consent to the furnishing of myself, my spouse, or any child of mine of such medical care, attention, and treatment by any hospital, physician, or dentist as such hospital, physician, or dentist may deem necessary or advisable, including any x-ray examination, anesthetic, medical, or surgical diagnosis or procedure. 2. I authorize any adult associated with the activity to consent to such medical care, attention, and treatment. 3. I agree to pay the reasonable cost of such medical care, attention, or treatment and to indemnify and hold free and harmless of and from any and all liability for such cost the assisting adult, AYC and the officers, employees, and members of said organization. I understand that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached.*

I agree

In consideration of acceptance of my child’s registration to participate in the 2018 Junior Sailing Program and, recognizing the risks associated with the sport of sailing, the undersigned hereby waives all claims for personal injury and property damage and hereby releases the Austin Yacht Club, and their directors, officers, members, employees, volunteers, and sponsors, of and from any and all claims, including those of negligence, which I or my child might have, arising out of my child’s participation in the Junior Sailing program and all activities relating thereto.*

I agree

I understand that the registration of a student is considered an acceptance on his or her part, and on the part of his parents or guardians, of all rules and regulations of Austin Yacht Club and the Junior Sailing Program. I agree to abide by the Austin Yacht Club Membershp Handbook and the Junior Sailing Program Handbook.*

I agree

Practice Registration:

AYC Member Registration

Price: $75.00

Non-member Registration

Price: $100.00

Total

$0.00

Total must be paid in FULL via PayPal on the next page to reserve your spot!

Total to be billed to AYC Member Account:

$0.00

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