High School Sailing Registration

Participant Information:
Face masks are required for participation.
Participant Name:*
First Last
Are you an AYC Member?*
- Yes
- No
AYC Member Number:*
Date of Birth:*
MM slash DD slash YYYY
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*
How many seasons have you participated in?*
Hidden
Have you turned in a PE Waiver to your High School counselor?*
- Yes
- No
LTISD and EISD only.
Hidden
Who is your school counselor?*
Hidden
Do you have a skipper or crew request?*
If you do not have a skipper or crew request, we will assign you a sailing partner.
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:
Medical Release: 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 AYC or while participating in any activity sponsored by or under the auspices of AYC under circumstances where I am physically unable to consent or am not present, (a) 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. (b) I authorize any adult associated with the activity to consent to such medical care, attention, and treatment. (c) 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 directors, 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
Liability Release: In consideration of acceptance of Participant’s registration to participate in the Junior Sailing Program and/or take private sailing lessons, recognizing the risks associated with the sport of sailing, the undersigned hereby waives all claims for personal injury and property damage and hereby releases AYC, and its 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, private sailing lessons, and all activities relating thereto.*
- I agree
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. AYC has put in place preventative measures to reduce the spread of COVID-19; however, AYC cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, participating in activities at AYC, including but not limited to the Junior Sailing Program and private sailing lessons could increase your risk and your child(ren)’s risk of contracting COVID-19. (A) By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that Participant and I may be exposed to or infected by COVID-19 by participating in AYC activities and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at AYC may result from the actions, omissions, or negligence of myself and others, including, but not limited to, AYC employees, members, volunteers, and Junior Sailing Program participants and their families. (B) I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to Participant or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or Participant may experience or incur in connection with participation in the AYC Junior Sailing Program or taking private sailing lessons (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless AYC, its directors, officers, members, employees, volunteers, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of AYC, its directors, officers, members, employees, volunteers, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any AYC program.*
- I agree
Practice Registration:
AYC Member Registration*
- Member registration fee
Non-member Registration*
- Non-member registration fee
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

High School Sailing Registration

Participant Information:

Parent/Guardian Information:

Medical Info & Release

Practice Registration: