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PONTCHARTRAIN YACHT
CLUB
SUMMER SAILING CAMP 2008
(985)
626-3192
Monday
– Friday*
Ages 8 –17
SESSION # 1 * Monday,
June 2 - 13
SESSION # 2 Monday, June 16 - 27
SESSION # 3 * Monday, June 30 – July 11 *no
class on Friday- July 4th
SESSION # 4 * Monday, July 14 – July 25
SESSION # 5 Monday, July 28 – Aug 7
Limited space available
per session / Lessons given by US Sailing Certified Instructors
Activities include
boating safety, basic boating skills and swimming (pool). Boats include: Sunfish, Optimist, 420’s and
Flying Scots.
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REGISTRATION FEES PER SESSION
MEMBERS – $300.OO** NON-MEMBERS
- $350.00**
10% discount applied for 2 or more children per family and/or2
or more sessions
A 50% DEPOSIT IS REQUIRED
per CHILD. THE DEPOSIT IS 100%
REFUNDABLE IF CANCELLATION IS RECEIVED TWO WEEKS PRIOR TO THE SESSION START DATE.
NAME
_ AGE______ DOB
MEMBER: YES ____ CLUB NAME______________ CLUB # ____ NON-MEMBER
DAY
PARENT’S
NAME PHONE
ADDRESS Zip _______________
SESSION
ALL
OF THE ABOVE MUST BE COMPLETE*
For
more information call PYC at 626-3192.
Check
our web site at www.pontyc.org/ Email: office@pontyc.org
*MUST
BE COMPLETED ALONG WITH A CONSENT FORM & RETURNED TO THE CLUB.
Child’s Name(s):
_____________________________________________________________________
PONTCHARTRAIN
YACHT CLUB SUMMER SAILING CAMP
JUNIOR
ACTIVITIES
PARENT’S
CONSENT
WAIVER OF
LIABILITY-ASSUMPTION OF RISK-INDEMNITY AGREEMENT
The
undersigned parent or legal guardians (hereafter referred to in the singular)
of __________________________________________(herein
referred to as the “child”), request that the child be allowed to participate
at Pontchartrain Yacht Club (herein referred to as PYC) junior activities
(herein referred to as “the activities”).
This
agreement shall remain in effect for the duration of the membership, or until
the end of the activities described above or upon PYC’s receipt of written
notice of the cancellations of the consent.
In
return for the child being permitted to take part in the activities and to use
the facilities and property of PYC, each of us makes the following promises and
warrants the truth of the following facts:
1. I am familiar with the programs included in
the activities, and understand officers and employees of PYC are available to
discuss the activities if I should wish additional information. I also understand I am solely responsible for
the arrival and departure of my child at the beginning and end of each day’s
program. I will not allow my child to remain
on the premise of PYC after each day’s program without appropriate supervision
or the written permission of PYC. I agree PYC will have no responsibility for
the supervision of my child at times other than during the scheduled
activities. I will inform my child that
he/she is expected to cooperate with, and follow the directions of the
person(s) in charge of the activities and to act in a manner consistent with
the spirit of good sportsmanship and respect the rights of others. For the safety of my child and the other
campers, if the staff is required to disciplined my child, I am aware of the following
procedure: 1st time – Head
Instructor to discipline by removing child from activities or assist in extra
duties, 2nd time- a meeting with the head instructor, PYC Board member(junior chairperson) and parents, 3rd time
– board member has the right to remove the child from camp with no refund. (PLEASE INITIAL TO INDICATE YOU HAVE READ
THIS PARAGRAPH.______)
2. My child is in good health, and I know of no
reason why he/she would be incapable to participate in the activities. My child knows how to swim. I will immediately notify the designated PYC
supervisor, if a change in my child’s health or other conditions would affect
my child’s ability to participate in the activities.
3. WAIVER OF LIABILITY: I waive and release any right I, legal
representatives and assigns may have or acquire to make a claim against, sue,
attach the property of, or prosecute PYC or any of its members, directors,
officers, agents, employees, and affiliated organizations (herein referred to
as “the releases”) for monetary damages caused by injury to myself or damage to
the property of myself arising from the participation in the activities and use
of facilities and property of PYC, whether or not the injury results from the
negligence or other action, except
intentional acts, of any of the releases. (Please
initial to indicate you have read this paragraph. ______)
4. ASSUMPTION OF RISK: I am aware that the activities may involve
maneuvering a boat, sailboard or other watercraft on deep waters in potentially
hazardous conditions which may include, among other things, strong winds and
high waves, sudden and unexpected immersion in deep waters and collisions with
other watercraft or stationary objects, such as docks, pilings, and buoys. With knowledge of the dangers involved, I
voluntarily ask that my child be allowed to take part in the activities. I ACCEPT ANY AND ALL RISKS TO MY CILD OF
INJURY, DEATH AND PROPERTY DAMAGE ARISING FROM PARTICIPATION IN THE ACTIVITIES AND
THE USE OF THE FACILITIES AND PROPERTY OF PYC, WHETHER OR NOT CAUSED BY THE
NEGLIGENCE OR OTHER ACTION, EXCEPT INTENTIONAL ACTS.. (Please
initial to indicate you have read this paragraph. _____)
Continued on page 2
Page
2
5. INDEMNITY AGRREMENT: I agree to indemnify and hold Pontchartrain
Yacht Club harmless from any loss, liability, damage or cost, including
reasonable attorney fees, that may incur due to my participation in the
activities and the use of the property and facilities of PYC, whether or not
such loss, liability, damage or cost results from negligence or other action,
except intentional acts, of any person.
(Please initial to indicate you have read this paragraph. ________)
I HAVE CAREFULLY READ THIS AGREEMENT
AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THE AGREEMENT INCLUDES A WAIVER
OF LIABILITY, AN ASSUMPTIONOF RISK AND AN AGREEMENT BY ME TO INDEMNIFY THE
RELEASES, AND I SIGN IT OF MY OWN FREE WILL.
DATE:
________________________
SIGNATURE
__________________________________________
(PLEASE PRINT NAME)
AUTHORIZATION TO CONSENT TO TREATMENT FOR CHILD.
I
______________________________ do hereby consent to any emergency X-ray,
anesthetic, medical or surgical diagnosis or treatment and hospital care which
is deemed advisable by, and is to be rendered under the general supervision of
any physician and surgeon licensed under provision of the Medical Practice
Act.
It
is understood that this authorization is given in advance of any specific
diagnosis, treatment or hospital care being required but is given to provide
authority and power of the part of our aforesaid agent (s) to give specific
consent to any and all such diagnosis, treatment or hospital care, which the
aforementioned physician in the exercise of his best judgment may deem
advisable: and neither said agent or any organization involved assumes any
financial responsibility for exercising this action.
1. FAMILY DOCTOR ___________________________ PHONE:__________________-
2. PERSON TO CONTACT IN EMERGENCY: 1.___________________________-
PHONE__________________________
2. __________________________
PHONE__________________________
3. MEDICAL CONCERN OR ANY LEARNING DISABILITIES
_______________________
4. KNOWN ALLERGIES:
______________________________________________________
5. HOSPITAL INSURANCE PLAN NAME & NUMBER
_____________________________
__________________________________-
SIGNATURE
IMPORTANT SAIL
PLEASE
BE HERE BY
THE
FOLLOWING IS A LIST OF SUPPLIES NEEDED FOR CAMP: