CYC Youth Sailing Camp Application
Please use this form to register your child for our summer Program
You can fill out and print this form on line

Parent's Name
Child 1 Name Date of Birth
Child 2 Name Date of Birth

Street City
State ZIP
Home Phone Cell Phone
E-Mail Address

Already a Member of CYC?    Yes     No                Amount Enclosed ($100 per child) $
Interested in Sailing:     Optimist      Sunfish
Parent Willing to Volunteer:    Yes     No
Have you Been to Another Sailing Program?     Yes      No

If Yes:  Where?    When?
Sailing Certificate From:

Consent, Release and Indemnity Agreement

I, , request that my son(s)/daughter(s), , be permitted to participate in the Colington Yacht Club Junior Sailing Program and in consideration of my child being permitted to participate in said activities, I hereby release and discharge the Colington Yacht Club (CYC) and the Colington Harbour Association, Inc. (CHA), its agents, officers, directors and members from any and all liability of whatsoever kind for any personal injury, sickness, or medical or hospital expense occurring or resulting from or arising out of any activity or substitute activity directly or indirectly connected with CYC’s Junior Sailing Program, and I hereby assume all risk of any liability for injury or damage to the person or property of my son/daughter, while engaged in such activities, however caused, and I further agree to indemnify and save harmless the CYC and the CHA, its agents, officers, directors and members from any and all claims, suits, and liability for injury to the property or to the person of my son/daughter, while engaged in activities at or connected with the CYC Junior Sailing Program.

This program does not provide health and accident insurance since most families already carry such coverage. Because of this, we ask that you, as a parent, recognize the element of risk and agree to assume that responsibility for yourself and your child.

_____________________________________     ___________
Parent or Guardian’s Signature                         Date

Please Mail this Form, the Medical Form and Fee to Or Contact Al Douglass at
Colington Yacht Club
Youth Sailing Program
141 Roanoke Drive
Kill Devil Hills, NC 27948
215-605-7312
YouthProgram@ColingtonYachtClub.com