Child 1 Name
Date of Birth
Child 2 Name
Date of Birth
Already a Member of CYC? Yes
Amount Enclosed ($100 per child) $
Interested in Sailing: Optimist
Parent Willing to Volunteer: Yes
Have you Been to Another Sailing Program? Yes
If Yes: Where?
Sailing Certificate From:
Consent, Release and Indemnity Agreement
, 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, 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 Colington Yacht Club’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 Colington Yacht Club, 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 Colington Yacht Club 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