SCHOOL HOLIDAY COURSE INTRODUCTORY/INTERMEDIATE REGISTRATION AND ENROLMENT FORM

Course Dates

Address

Address Line 1*

Address Line 2

City*

State / Province / Region*

Postal Code / Zip*

Country

Mobile Phone Number

Home Phone Number

Emergency Contact 1

Emergency Contact 2

Medical Condition/s

Asthma or Respiratory Condition

Diabetes or Hypoglycemia

Epilepsy

Hearing or Vision condition

Heart or circulatory condition

Haemophilia/other bleeding condition

Other

None of the above

Allergies

Medication

Bee sting or other insect bites

Foods - please elaborate below

Other

None of the above

If "other" please state, or elaborate on condition/medication listed

Student is capable of swimming how many metres unassisted?

Sailing Experience - please note years, type of boat/s, sailing club and reason for doing the course. If left blank we will assume you have never sailed before.

General Disclaimer, Acknowledgment of Risk and General Club Liability:

To: Cruising Yacht Club of Australia ("CYCA") And To: Each sponsor, officer, employee, volunteer and member for the time ("other party")

The person whose details are set out above:

acknowledges and accept the risks associated with participation in any course, event or program and waiver all rights against and releases CYCA, Youth Sailing Academy and each Other Party in respect of any loss of life of injury to persons, or loss of or damage to property, suffered in connection therewith;
acknowledges that participation in any course, event or program is entirely at my own risk and responsibility;
acknowledges and agrees that this form is governed by the law of NSW and that any liability for harm to persons that results from breach of an express or implied warranty that any course, event, program and all services relating thereto will be conducted or rendered with reasonable care and skill is excluded.

I, the undersigned, hereby indemnify the Cruising Yacht Club of Australia, its directors, officers and members from any claim for breach of duty of care whilst participating in the Youth Sailing Academy. I expressly agree and declare that I indemnify the Cruising Yacht Club of Australia and the Youth Sailing Academy against all claims and demands in respect of death, bodily injury or damage to property occurring whilst enrolled or participating in any course, event or program controlled by the Youth Sailing Academy.

Sign Here (parents signature if student under 18)

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Cost :- for first time participants $450* including Youth Sailing Academy T-shirt.

Discounts :- Families receive a $50 reduction for 2nd family member and $100 for a 3rd in the same course. Students on their 2nd course pay only $375* or $325* for 3rd & subsequent courses

Credit Card Details

Name On Card

Card Number

Card Expiry

Amount