Saturday "SYSTEM" Sailing Program 2024-2025

Winter 2025 "SYSTEM" Sailing+Youth+STEM Program Application

Saturdays from 10:00 to 3:00 -- January 11th - March 1st -- (3/15 make-up day if needed)
Sailor's Name*

First NameLast Name
Sailor's Email Address*
example@example.com
Sailor's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian #1 Name *

First NameLast Name
Parent or Guardian #1 Cell Phone Number*

Area CodePhone Number
Parent or Guardian #1 E-Mail Address*
example@example.com
Parent or Guardian #2 Name *

First NameLast Name
Parent or Guardian #2 Cell Phone Number*

Area CodePhone Number
Parent or Guardian #2 E-Mail Address*
example@example.com
Emergency Contact (Someone Other Than Parent/Guardian)*

First NameLast Name
Emergency Contact's Relationship to Sailor*
Emergency Contact Phone Number*

Area CodePhone Number
Sailor's Birthdate (Must be between the age of 9 and 14)*

MonthDayYear
Date
Sailor's Height (ft. in.)*
Sailor's Weight (lbs.)*
Allergies: List allergies*
Medical Conditions we Should be Aware of: List medical conditions*
Intellectual or Developmental Conditions: List any cognitive/intellectual conditions that might interfere with sailor's ability to follow instruction*
Sailor's Gender*

MaleFemaleOther
If "Other" was chosen for the sailor's gender, plese explain:
Sailor's Race (choose all that apply)*

CaucasianHispanic/Latino/SpanishAfrican AmericanNative Hawaiian/Pacific IslanderAsianAlaskan NativeMiddle EasternHow I Identify is Not Represented HerePrefer Not to Say
How Would You Rate Sailor's Water Comfort?*

Non swimmerLow level of water comfortCompetent swimmer and comfortable in waterHighly competent swimmer
Prior Sailing Experience*

NoneFrom Team Paradise SailingFrom another sailing programFrom sailing with family and friends
Name of School Sailor Attends (or home school group):Name of School*
Household Income*

Less than $25,000$26,000 - $50,000$51,000 - $75,000$76,000 - $100,000Over $100,000
Household Info.*

Two-Parent HouseholdSingle-Parent HouseholdCustodial Grandparent/Guardian
Does Your Sailor Receive Free or Reduced Meals at School?*

YesNoPrefer Not to Answer
Is there anything else you would like us to know about Sailor? (For example, behavioral, cognitive or physical ability information.)
Should be Empty:

Winter 2025 "SYSTEM" Sailing+Youth+STEM Program Application