Cedar Island Yacht Club Youth Sailing Registration Form

In cooperation of our partners Ontario Sailing, the Town of Kingsville and Truax Lumber, Cedar Island Yacht Club is pleased to present the BOOM Youth Sailing Program.

Name of Participant *

Name of Parent or Guardian *

Address *

City *

Postal Code *

Email Address *

Date of Birth *

Age *

Emergency Contact *

Relationship *

Phone *

Alternate Emergency Contact *

Relationship *

Phone *

Family Doctor *

Phone *

Health Card Number *

Are there any medical, learning or behavioural conditions BOOM should be aware of (including insect, food and medical allergies?) *

If you answered yes, please explain.

Please list who will be dropping off/picking up the participant. *

Telephone *

Telephone

Course Location: Cedar Island Yacht Clb, 982 Heritage Road, Kingsville, ON

I would like to participate in the course(s) noted below: *

July 23 - 27

July 30 - August 3

If my preferred dates are not available, I am willing to register for the alternate week. *

Yes

WAIVER: I understand that it is a condition of my participating in this program that I do so at my own risk. Therefore, in consideration of my acceptance of entry into this program, I agree to save harmless and keep indemnified Ontario Sailing, the host club or organization, the Canadian Yachting Association, the organizers and their respective agents, officials, servants and representatives from and against all claims, actions, costs, expenses and demands in respect to death, injury, loss or damage to my person or property, howsoever caused, arising out of or in connection with my taking part in this program, notwithstanding that the same may have contributed to or caused or occasioned by, the negligence of the same bodies, or any of them, or their agents, officials, servants or representatives. I further understand and agree that this release is binding upon myself, my heirs, executors and assigns. I understand that photographs and/or videos taken of program participants, staff may be used for promotional purposes and I hereby consent to such by Ontario Sailing. I have read and understand Ontario Sailing's Privacy Policy. (www.ontariosailing.ca)

By clicking "I Accept", I confirm that I am the participant's parent or guardian (or the participant if I am 18 years of age or older). I further confirm that I accept the terms of the above-noted Waiver. *

I accept

* +

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