<p> Ranelagh Yacht Squadron Kidsail Registration – Season 2016-2017</p><p>PARTICIPANTS DETAILS</p><p>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 </p><p>(To be completed by legal Parent or Guardian, additional forms required if participant address differs)</p><p>Adult / Parent or Guardian: Surname...... Given Name...... </p><p>Address...... </p><p>Phone AH:...... Phone BH:...... Mobile:...... </p><p>Email Address: ………………………………………………………………………………..……….</p><p>Person to contact in an emergency Name...... </p><p>Emergency Contact Phone...... </p><p>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: ………………………………………………………… ………………………………………………………… ………………………………………………………… ………………………………………………………… …………………………………………………………</p><p>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.</p><p>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.</p><p>I agree to pay for all expenses incurred in obtaining such medical aid and to reimburse the organization for any expenses incurred.</p><p>1 | P a g e 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:</p><p>Signature …………………………………………………………………………</p><p>Printed name …………………………………………………………………… Address ………………………………………………………………………… Date ………………………………………………………………………………</p><p>Signature, parent or guardian ………………………………………………… (if under age 18)</p><p>PARTICIPANT INDEMNITY FORM</p><p>I ...... (Parent or legal guardian) hereby give permission for </p><p>...... ……...... </p><p>&...... (Participating children) to participate in Ranelagh Yacht Squadron’s Sail Training Program 2016-17. </p><p>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. </p><p>SIGNED...... </p><p>DATE...... </p><p>Name in Block letters...... </p><p>PAYMENT OPTIONS</p><p>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)</p><p>☐ Visa ☐ Master Card Expir CCV y APPLICATION</p><p>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. </p><p>Applications need to be:</p><p>Handed to Administration - Ranelagh Club</p><p>Or</p><p>Sent to Attn: RYS, Ranelagh Club, 3 Rosserdale Cres, Mt Eliza 3930, or drop off at club.</p><p>Please ensure payments are made at the time of booking to avoid disappointment</p><p>KIDSAIL COURSE DATES / COSTS</p><p>Training for 4 day program will commence:</p><p>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.)</p><p>Cost for Members: $295.00 GST inclusive </p><p>Cost for Junior Non- members inclusive of membership for the 2016/17 season: $395.00 incl. GST</p><p>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!</p><p>Junior: T Shirt Size: 8 10 12 14 16 L</p><p>Club Clothing – RYS branded Polo Shirts & Caps are available for purchase. Please ask for details at the office. </p><p>3 | P a g e</p>