PART 1 - Registration

Head of Household (Parent/Guardian)

Participant Information

Household information

(used for grant applications)

Emergency Contacts

Jolly Madison Sailing Club Behavior, Sickness and COVID-19 policies

(Parents/Guardians authorize the staff permissions below by checking the require box below and also provide your signature indicating your acknowledgement and understanding of our policy. )

By signing below, I agree to uphold the Member Pledge & Principles.

I grant Jolly Madison Sailing Club permission to:

ABOVE PERMISSIONS: Videos and Pictures can be used in one or all of the following: instagram posts, facebook posts, promotional marketing. Members will, through JMSC camp, learn to sail 420 and JY 14 sailboats, with instructors and peers. Students may engage in a few short surveys regarding their camp experiences/learning objectives from their session.

WAIVER OF DISABILITY AND DISCLAIMER: In consideration of my child's membership and participation in the activities and program of Jolly Madison Sailing Club, I, as parent or guardian of named minor, my heirs, executors, administrators and assigns, waive, release, and discharge any and all rights and claims or damages against the Club and/or its sponsors for knowledge of the risks involved in said participation and that my child is in good health and has no physical or mental condition which would make it dangerous for my child or for other participants when my child is involved in any of the sponsored activities.

Emergency Authorization

I hereby give permission to medical personnel selected by Jolly Madison Sailing Club, its employees, agents, directors, volunteers, or sponsors to provide or seek emergency treatment, (including x-rays) for my child in the event I cannot be reached in an emergency. However, the giving of my permission does not obligate Jolly Madison Sailing Club, its employees, agents, directors, volunteers, or sponsors to arrange such care except as may be directed by medical personnel.

I certify that the information above concerning the applicant is accurate:

PART 2 - Registration Acknowledgement

All information requested on our membership application is kept strictly confidential.

Free/reduced lunch status and race/ethnic background information is needed and ONLY used for grant funding and reporting purposes.

Assumption of Risk, Release of Liability, Covenant Not to Sue, and Permission Slip for Participants in the Adventure Sports Programs

Parents: THIS FORM IS REQUIRED FOR ALL MEMBERS PARTICIPATING IN THE JOLLY MADISON SAILING CLUB CAMPS AND ACTIVITIES. IT CONTAINS A GENERAL RELEASE, COVENANT NOT TO SUE AND WAIVER OF CLAIM AGREEMENT BARRING
THE PARTICIPANT OR YOU, THE PARTICIPANT'S PARENT/GUARDIAN, FROM BRINGING ANY CLAIM FOR PERSONAL INJURY AND/OR DEATH WHICH IS IN ANY WAY RELATED TO PARTICIPATION IN ANY ADVENTURE SPORTS ACTIVITY. WHEN SIGNED BY YOU, IT IS LEGALLY BINDING AND IS MADE BY YOU IN FAVOR OF JMSC, AND EACH OF ITS PROGRAMS, AFFILIATES, DONORS, EMPLOYEES, CONTRACTORS, AGENTS, VOLUNTEERS AND ASSIGNS, AND THE BOARDS OF DIRECTORS, DONORS, EMPLOYEES, CONTRACTORS AND AGENTS OF ORGANIZATIONS.

In consideration for JMSC hereby covenant and agree as follows:

Consent to Participate in the Program. I am the parent or legal guardian of a minor
(hereinafter referred to as "my child"). I agree my child may participate in the JMSC Summer Sailing Program, which I understand includes activities JMSC organizes and runs directly. I understand and acknowledge my child's participation in the Jolly Madison Sailing activities is voluntary. I understand that during the activities my child will be engaged in outdoor physical activities, and my child may be exposed to physical hazards, emotional demands, communicable diseases, weather conditions or other unanticipated events. I recognize that these activities are inherently dangerous activities and am aware that there is always risk of permanent physical or mental injury, including paralysis and death and damage to my child and/or my child's (or my) property when participating in such activities.

Acknowledge Child's Ability. In my judgment, my child is competent and capable of participating despite these risks. In particular, my child possesses basic swimming ability and is able to tread water in a lifejacket.

Assumption of Risk. On behalf of my minor child, I assume all risks of my child's participation in these sailing/adventure activities and related programs, those that are obvious and necessary, and all other risks of property damage, personal injury, serious personal injury and/or death.

Release, Covenant Not To Sue, Hold Harmless. On behalf of myself, my minor child, and our heirs successors and assigns, I hereby release, covenant not to sue, and agree to defend and hold harmless JMSC, and each of its programs and partners, the Boards of Directors, officers, donors, sponsors, employees, and volunteers from any and all liability, loss or damage, actions, claims and demands which now have or which may hereafter arise from my child's (or my) participation in all JMSC sports and activities.

Certification and Authorization; Emergency Treatment. I hereby certify that my child is in normal health, and to my knowledge, is capable of participating safely in the Sailing activities and programs of Jolly Madison Sailing Club.

Should any injury occur to my child during participation in said programs, I authorize Jolly Madison Sailing Club to arrange for or to provide emergency medical treatment and to arrange for or provide transportation to the nearest qualified medical facility. I give Jolly Madison Sailing Club and medical treatment staff and personnel permission to administer to my child should my child be injured while attending activities at Jolly Madison Sailing Club Camps. I also understand that Jolly Madison Sailing Club does not carry medical insurance for the Sports participants and it is my responsibility to pay any bills associated with such treatment and any emergency transportation.

Computer Access. I give my child permission to use Jolly Madison Sailing Club computers/cell phones or those provided by our sponsors, and to access the internet appropriately for educational purposes.

Photo, Media Release. I agree to allow my child's photograph, video, multimedia or film likeness and/or name to be used for any legitimate purpose by Jolly Madison Sailing Club and/or their assigns without payment or compensation. I assign to Jolly Madison Sailing Club and/or their assigns all rights I may have to my child's participation, photo, video or film likeness that have been captured in connection with. I consent to my child appearing in any reproduction or broadcast(s) of any Jolly Madison Sailing Club Sports activity in perpetuity.

This Agreement contains all the terms of the Agreement of the parties hereto. No other terms apply to or amend this agreement unless otherwise made in writing and signed by Jolly Madison Sailing Club and the undersigned. This Agreement is made, subject to the laws of the State of Michigan.

WARNING: BY SIGNING THIS DOCUMENT YOU ARE WAIVING CERTAIN LEGAL RIGHTS. PLEASE READ THE ENTIRE DOCUMENT CAREFULLY. ALL PARTICIPANTS MUST SIGN THIS FORM TO PARTICIPATE IN JOLLY MADISON SAILING CLUB ADVENTURE SPORTS ACTIVITIES AND PROGRAMS. THIS RELEASE SHALL BE EFFECTIVE FOR THE ENTIRE TIME AS OF ITS EXECUTION UNTIL THE UNDERSIGNED PARENT OR GUARDIAN EXPRESSLY REVOKES THE CONSENTS HEREIN IN.

IN WRITING BY THE UNDERSIGNED. THE UNDERSIGNED ACKNOWLEDGES THAT HE OR SHE HAS READ AND UNDERSTANDS THIS RELEASE AND WAIVER OF LIABILITY IS A RELEASE OF SPECIFIC LEGAL RIGHTS AND REMEDIES AND THAT BY EXECUTING THIS RELEASE AND WAIVER OF LIABILITY INTENDS THAT ITS PROVISIONS SHALL BINDING UPON THE UNDERSIGNED, HIS OR HER CHILDREN, REPRESENTATIVES, SUCCESSORS AND ASSIGNS. BE MINOR HEIRS,

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

(A Jolly staff member may contact you regarding this information/concern)