JSP Town Resident Registration

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 2021 season?*

Yes

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 State Zip

Primary Phone*

Alternate Phone

Classes Schedule
Harbor Rookies (Fri 9:30-10:45 OR 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. For the 2021 season, participation in regattas (TBD) is likely to be affected by COVID travel and gathering restrictions, leaving us unable to predict how many regattas we will be able to attend.Race Team meets Monday, Wednesday, Thursday, and Friday 1:30-4:30.

June 21

June 28

July 5

July 12

July 19

July 26

August 2

August 9

Date of Birth*

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*

Medications

List medications, if any, that your child is currently taking

Medical Information*

Please check all that apply

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

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

JSP Town Resident Registration

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Buck’s Harbor Yacht Club