Parental Consent and Release for NSA Junior Sailing

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 $360.00.

Sailors attending both Morning and Afternoon classe during the same week, are encouraged to bring their lunch and stay at the clubhouse with the instructors between the sessions.

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.

Wait List Session Requested*

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)*

How did you find NSA?*

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

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.

NSA Jr. Sailing Program 2024 WAITING LIST

Choose One or More Of The Class Sessions Below