Parental Consent and Release for NSA Junior Sailing

NSA WAIT LIST Pre-Registration, Health & Parental/Guardian Consent Form For 2023 Season

You must complete a separate form for each wait list request you make per child
Junior Sailor Name:*

Junior Sailor's First NameJunior Sailor's Last Name
Junior Sailor's Age At Class Date*
Age Must Be 8 to 18
Junior Sailor's Date of Birth:*

MonthDayYear
UNISEX T-Shirt Size*
Small
The cost for one week of Morning or Afternoon Classes is $340.00.

An ALL-DAY discount of $35. will be given to sailors who take both classes in the same week. ALL-DAY sailors are encouraged to bring their lunch and stay at the clubhouse with the instructors between the Morning and Afternoon classes.

Payment is not due until the first day of each class week.

An invoice with a payment link will be emailed to you a few days before each class begins.
Check One or More Of The Available Class Weeks Below

To sail "ALL-DAY" check both the Morning AND Afternoon boxes in the same week
MORNING Class 9:00 am - 12 noon Choose Week(s)
AFTERNOON Class 1:00 pm - 4:00 pm Choose Week(s)
ALL DAY Class 9:00 am - 4:00 pm Choose Week(s)
Name of Parent/Legal Guardian:*

Parent/Legal Guardian First NameParent/Legal Guardian Last Name
Name of Person Authorized to pick child up if different

Person Authorized First NamePerson Authorized Last Name
Name of Additional Person Authorized to pick child up if different

Person Authorized First NamePerson Authorized Last Name
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Cell Phone Number:*

Area CodePhone Number
Emergency Contact Cell Phone Number if different:

Area CodePhone Number
While NO sailing skill is required to register, which of these best describes your child's sailing ability?*

BEGINNER (has no or very limited sailing experience)NOVICE (has learned some fundamentals of sailing through family or other instruction)INTERMEDIATE (knows sailing fundamentals and terms, and can follow instruction as a crew member of a small sail boat)ADVANCED (can confidently skipper a small sail boat alone and instruct a crew)
Allergies or Medical / Physical Conditions: (Check all that apply)*

Insect Sting or BitesPenicillin or Other DrugsPoison Sumac, Ivy, or OakFood Reactions or RestrictionsPrescription Glasses / ContactsDental / OrthodonticsOrthopedic or Special EquipmentNoneOther Not Listed
How did you find NSA?*

Past student/family participationGoogle SearchWord of Mouth/RecommendationOther web search
Consent & Permission

In consideration of the acceptance of my child/grandchild/ward in the Junior Sailing Program held by or under the auspices of the Namequoit Sailing Association, I hereby agree:

1. To release said Association and its respective officers, directors, other agents and members from any/and all personal injuries that may occur to my child/grandchild/ward in connection with the participation of my child in the sailing program conducted by Namequoit Sailing Association.

2. To indemnify and hold harmless said Association and their respective officers, directors, other agents and members from any and all claims for any loss of, or damage to, personal property, or the property of any other person, and for any claims for any personal injuries arising from or resulting from any acts or omissions of acts of my child/grandchild/ward in connection with the participation in the Sailing Program held as aforesaid or conducted as aforesaid.

3. I hereby grant permission to NSA to use unattributed photo images for use in promotion of the NSA junior sailing program and can include but is not limited to, website, newsletters, and limited printed materials without compensation or recognition.

In consideration of the acceptance of my child/grandchild/ward in the Sailing Program of the Namequoit Sailing Association held as aforesaid or conducted as aforesaid, I individually agree to be bound by all the foregoing terms, conditions, releases and indemnification specified. I give permission for the above-named youth(s) to participate in all of the activities of the Youth Sailing Program, including transportation to and from events.

Parent/Guardian Emergency Treatment Authorization

I hereby grant permission to any qualified first responder or health care professional to give any and all medically appropriate emergency care to my son/daughter/ward including but not limited to anesthesia and surgery.
Todays Date:*

MonthDayYear
Signature of Parent/Legal Guardian:*

Please Click & Sign with Cursor or Use Finger Tip on Mobile Device Clear
Please confirm by checking the box*
IMPORTANT: After submitting this form you will receive an email confirmation and be redirected to the Junior Sailing Program Webpage. If you want to WAIT LIST another child, please click the registation button on that page.

You will be notified if an opening becomes available ASAP and this pre-registration information will be used to enrolled you juniuor sailor into the selected classes.
Should be Empty:

NSA WAIT LIST Pre-Registration, Health & Parental/Guardian Consent Form For 2023 Season

Check One or More Of The Available Class Weeks Below