Application Form for Ranelagh Yacht Squadron S

Ranelagh Yacht Squadron

Kidsail Registration – Season 2016-2017

PARTICIPANTS DETAILS

Participant’s Full Names (minimum age 8):

Participant 1………………………………………………………DOB...... Reg No ...../12

Participant 2………………………………………………………DOB...... Reg No ...../12

Participant 3………………………………………………………DOB...... Reg No ...../12

Participant 4………………………………………………………DOB...... Reg No ...../12

(To be completed by legal Parent or Guardian, additional forms required if participant address differs)

Adult / Parent or Guardian: Surname...... Given Name......

Address......

Phone AH:...... Phone BH:...... Mobile:......

Email Address: ………………………………………………………………………………..……….

Person to contact in an emergency Name......

Emergency Contact Phone......

Are any of the listed participants subject to a relevant condition that may affect their ability to participate or require special attention (e.g. medication etc.)?

YES / NO

If Yes please provide details:

…………………………………………………………

I authorize the Leaders-in-charge to obtain first aid, medical, ambulance, dental assistance or treatment, including any anesthetic or blood transfusion, for myself and/or child/children in the event of any illness or accident. Note: All reasonable attempts to make contact with the nominated “person to contact in an emergency” will be made.

I consent to the release of the health information on this form to any person who provides medical treatment and care to the applicant whilst participating in these activities.

I agree to pay for all expenses incurred in obtaining such medical aid and to reimburse the organization for any expenses incurred.

I grant to RYS the right to take photographs of my family and I in connection with the above-identified event. I authorize RYS, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that RYS may use such photographs with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and understood the above. I have completed this form and to the best of my knowledge the information is correct:

Signature …………………………………………………………………………

Printed name ……………………………………………………………………

Address …………………………………………………………………………

Date ………………………………………………………………………………

Signature, parent or guardian …………………………………………………
(if under age 18)

PARTICIPANT INDEMNITY FORM

I ...... (Parent or legal guardian) hereby give permission for

...... ……......

&...... (Participating children) to participate in Ranelagh Yacht Squadron’s Sail Training Program 2016-17.

I am aware that during the training course certain hazards may occur associated with sailing and boat rigging generally. I have and do hereby acknowledge all the above risks and will hold Ranelagh Yacht Squadron their associates and agents free of any liability action, debt claims or demands which I may have as a result of, or in connection with the participation in this course of instruction.

SIGNED......

DATE......

Name in Block letters......

PAYMENT OPTIONS

1. I have enclosed Cheque / Cash / for $......

(Cheques to be made payable to The Ranelagh Club)

2. My credit card details are; (or call the Club during business hours to make payment)

☐ Visa ☐ Master Card

Expiry / CCV

APPLICATION

Places will be provided on a first come first serve basis until full. Places cannot be guaranteed or secured until full payment is received, for which a confirmation will be provided prior to the start of the respective course.

Applications need to be:

Handed to Administration - Ranelagh Club

Sent to Attn: RYS, Ranelagh Club, 3 Rosserdale Cres, Mt Eliza 3930, or drop off at club.

Please ensure payments are made at the time of booking to avoid disappointment

KIDSAIL COURSE DATES / COSTS

Training for 4 day program will commence:

Monday 2nd January 2017 and run until Friday 6th January 2017

8:30am start, 2:00pm pick up

(Allowing 5 days for a 4 day program dependent on weather.)

Cost for Members: $295.00 GST inclusive

Cost for Junior Non- members inclusive of membership for the 2016/17 season: $395.00 incl. GST

Course Fee includes: Daily Lunch/snacks/Drinks, Log Books for new sailors, Awards Lunch & Certificates, Kidsail T shirt and welcome pack and of course expert tuition from our team of instructors!

Junior: T Shirt Size: 8 10 12 14 16 L

Club Clothing – RYS branded Polo Shirts & Caps are available for purchase. Please ask for details at the office.

1 | Page