"*" indicates required fields The junior sailing program at BHYC is offered free of charge on a SPACE-AVAILABLE basis to children who are year-round residents of the town of Brooksville. This does not extend to grandchildren, etc of year-round residents, the student MUST be a resident.Name of Person Filling out Form* First Last Email* Student Name*Is this the first time that this student has been registered for the 2025 season?* Yes No If yes, please fill out all required contact and medical information.Parents' Names*Parent's Email* Student's Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Primary Phone*Alternate PhoneClasses Schedule Harbor Rookies (M,W,F 11-12:15) Ballast (Mon-Thu 8:15-10:15 am) Apprentice Helmsman (Mon-Thu 8:15-10:15 am) Helmsman (Mon-Thu 1:30-4:00 pm) Skipper (Mon-Thu 10:30am-12:30 pm) Senior Skipper (Mon-Thu 10:30-12:30 pm) Opti Race Team (Tue & Thu 10:30-12:30) 420 Race Team (Mon, Wed, Thu 1:30 pm-4:30 pm) *Sailors in Skipper or above may participate in the 420 Race Team. BHYC typically sends a fleet of 3 boats (6 sailors) to a few regattas each summer. Boat pairings and regatta teams are determined by the race coach. Race Team meets Monday, Wednesday, Thursday, and Friday 1:30-4:30.June 23 Harbor Rookies 11-12:15 - week of June 23 Ballast - week of June 23 Apprentice Helmsman - week of June 23 Helmsman - week of June 23 Skipper - week of June 23 Senior Skipper - week of June 23 Opti Race Team - week of June 23 420 Race Team - week of June 23 June 30 Harbor Rookies 11-12:15 - week of June 30 Ballast - week of June 30 Apprentice Helmsman - week of June 30 Helmsman - week of June 30 Skipper - week of June 30 Senior Skipper - week of June 30 Opti Race Team - week of June 30 420 Race Team - week of June 30 July 7 Harbor Rookies 11-12:15 - week of July 7 Ballast - week of July 7 Apprentice Helmsman - week of July 7 Helmsman - week of July 7 Skipper - week of July 7 Senior Skipper - week of July 7 Opti Race Team - week of July 7 420 Race Team - week of July 7 July 14 Harbor Rookies 11-12:15 - week of July 14 Ballast - week of July 14 Apprentice Helmsman - week of July 14 Helmsman - week of July 14 Skipper - week of July 14 Senior Skipper - week of July 14 Opti Race Team - week of July 14 420 Race Team - week of July 14 July 21 Harbor Rookies 11-12:15 - week of July 21 Ballast - week of July 21 Apprentice Helmsman - week of July 21 Helmsman - week of July 21 Skipper - week of July 21 Senior Skipper - week of July 21 Opti Race Team - week of July 21 420 Race Team - week of July 21 July 28 Harbor Rookies 11-12:15 - week of July 28 Ballast - week of July 28 Apprentice Helmsman - week of July 28 Helmsman - week of July 28 Skipper - week of July 28 Senior Skipper - week of July 28 Opti Race Team - week of July 28 420 Race Team - week of July 28 August 4 Harbor Rookies 11-12:15 - week of August 4 Ballast - week of August 4 Apprentice Helmsman - week of August 4 Helmsman - week of August 4 Skipper - week of August 4 Senior Skipper - week of August 4 Opti Race Team - week of August 4 420 Race Team - week of August 4 August 11 Harbor Rookies 11-12:15 - week of August 11 Ballast -week of August 11 Apprentice Helmsman - week of August 11 Helmsman - week of August 11 Skipper - week of August 11 Senior Skipper - week of August 11 Opti Race Team - week of August 11 420 Race Team - week of August 11 Date of Birth* Month Day Year Height in feet and inches*Weight*Date of last tetanus shot?*Allergies*Check all that apply None Medicines Plants Foods Insect Bites Please list specific allergies*MedicationsList medications, if any, that your child is currently takingMedical Information*Please check all that apply None Asthma Epilepsy Circulatory/Heart Problems Hemophilia/Bleeding Problems Diabetes/Hypoglycemia Eyeglasses/Contact Lenses Hearing Aides Surgeries/Illnesses Other Please describe specific medical issue*Health Insurance Carrier*Policy Number*Pediatrician*Pediatrician Phone*Name of emergency contact #1*Emergency contact #1 phone*Name of emergency contact #2*Emergency contact #2 phone*In case of emergency, I understand that every effort will be made to contact me. In the event that none of the above listed contacts can be reached, I authorize the staff of Buck's Harbor Yacht Club to obtain medical treatment for my child. By entering my initials below, I give my consent.Photo Consent*I give permission for uncaptioned images (photos, videos, etc.) of the above named sailor to appear on BHYC social media such as the website or facebook page: Yes No Additional Information?Please let us know if there is anything we need to know that is not included in the registration.By typing in initials below, parent or guardian of the above named sailor understands and agrees to all of the following: (1) You and Buck’s Harbor Yacht Club (“BHYC”) have agreed to conduct this registration and release under Maine law by means of this electronic record and your typed initials below evidence your intent to sign and be bound by this record; (2) The junior sailor is participating in the BHYC’s Sailing Program at his/her own risk, and on behalf of the junior sailor and his or her household, we hereby release BHYC, its members, agents, and employees (together the “BHYC parties”) from all actions, causes of action, damages, claims, or demands which may arise against such BHYC parties for any and all injuries or illness caused by or resulting from participation in the Sailing Program, including injuries or illness caused by or resulting from negligence on the part of any such BHYC parties, and no one of us will file or maintain a civil action against any of the BHYC parties asserting a cause of action or claim hereby released; (3) There are inherent risks associated with the Sailing Program and, understanding those risks, chooses to have the junior sailor participate; (4) The junior sailor will not come to participate in any class unless at that time (a) there is no reason to suspect the junior sailor is infectious with SARS-CoV-2 (the virus that causes COVID-19), (b) there is no reason to suspect the junior sailor has had close, recent contact with anyone infectious with that virus, and (c) the junior sailor and his or her immediate household have complied with quarantine or other requirements then in effect, if any, applicable to them under any Executive Orders or other laws existing at that time to reduce the spread of COVID-19; (5) You will participate and cooperate with contact tracing if recommended or required by public health officials; (6) You will promptly inform BHYC of any current COVID-19 illness or suspected illness in the junior sailor’s household if the junior sailor has attended any class in the previous couple weeks; and (7) You agree to pay reasonable attorneys’ fees, reasonable paralegal fees, and reasonable costs of collection, incurred by BHYC or a BHYC party, if you breach or violate any of the terms or provisions set forth above, and BHYC and/or the BHYC party prevails in the enforcement of such term or condition in a court of law.Initials*Type initials above