Download Report

VERMILION SAIL CAMP 2015
in partnership with
Vermilion YMCA Youth Sports
Application Form
ONE NAME PER APPLICATION
Name:
Age:
Birth Date:
/
/
Address:
City:
State:
Home Phone: (
)
Mother’s Cell: (
)
Student’s t-shirt size
Zip:
Work Phone: (
)
Father’s Cell: (
)
E-Mail
VBC member
YMCA member
Please indicate the program you wish to attend below:
Non-member
Start Opti Sailing (SOS) Program: Sailing and Water Safety for Youngsters, Ages 5-7.
$100 Member/$150 Non-member early bird registration paid in full by
March 31st 2015applications received after will be an additional $25.00
Tuesday June 16, 23, 30, 7, 14th 5:30 – 8:00 pm
JY15 Program “Try Sail”: Sailing Program for Ages 8-16.
$125.00 member/$150.00 member early bird registration paid in full by April 30th
applications received after will be an additional $25.00
July 13th – July 16th 8:00 am - noon
---------------------------------------------------------------------------------------------------------------There will be a $25.00 late fee charge to any application received after May 6th
NOTE: If the instructors determine that intentional damage is done to the boat/s, a suspension from camp will
be issued. The parents of the camper will be held financially responsible for the amount to repair the boat/s. No
refunds after camp has started.
___________________________________
Signature of Parent or Guardian
If you have any questions please contact our website at vbcsc.com or
Colleen Rini (440) 967-2008 sailrini@yahoo.com
V.B.C. (440) 967-6634 vbc5416@centurytel.net
Mail applications to Vermilion Boat Club
5416 Liberty Ave Vermilion, Ohio 44089
Atten: Colleen Rini
VERMILION SAIL CAMP
All Programs Release
Form
Student Name
We, the undersigned parent or legal guardians of the abovementioned student do hereby acknowledge that we, as guardians of
said student, are awareof the
risks
and possibility
of injury
in connection with participation in the
Vermilion Sail Camp summer program. We hereby grant our
consent to our child’s participation in all Sail Camp programs
for the summer, including but not limited to, participation in water
sports
on-water and instruction on-water. We further agree not to
hold Vermilion Boat Club, Vermilion Sail Camp, Inc.,
Vermilion YMCA, or any of its officers, trustees, employees, or
agents in any way responsible
for any injuries which occur while said student is
participating in Vermilion Sail Camp, Inc., programs or which
may result from such participation.
Mother/Guardian
Date
Father/Guardian
Date
Date Received by Vermilion Sail Camp, Inc.
Publicity Exclusion Form
From time to time we may wish to post photographs and names of VBCSC campers
on our website, in the VBC Scuttlebutt, or the local newspaper. If you have an objection to
your child’s photo/name being used, please complete the form below. Campers who have
these forms on file with VBCSC will be excluded from Internet and print publicity
associated with VBCSC and YMCA.
As the parent(s) of Vermilion Boat Club junior Sailor
, I request that
my
child’s name/photograph be excluded from Internet/print publicity for VBCSC and YMCA.
parent(s) signature
parent(s) signature
date
VERMILION SAIL CAMP
All Programs Medical
Release
To Be Filled Out By Parent, Please Print:
Name:
Age:
Birth Date:
/
/
Address:
City:
Home Phone: (
State:
)
Zip:
Cell Phone: (
)
Emergency Contact:
Name:
Phone: (
)
Address: (if different from above)
City:
Personal Doctor:
State:
Zip:
Phone: (
)
Other Numbers:
Are you taking any medications at the time? If so, please specify:
Do you have any allergies that need medication? If so, please specify:
Do you have any identified learning or physical disabilities? If so, please specify:
If your doctor is not a local physician, it may not be in the best interest of your child to be
taken to your personal physician. It is, therefore, understood by the undersigned that the
above-mentioned camper may be taken to a local doctor at the discretion of the Vermilion Sail
Camp Staff.
Parent/Guardian Signature __________________________
Date _________________