Junior Sailing Program Registration

1JUNIOR SAILOR INFORMATION

2PARENT/GUARDIAN INFORMATION

3COMMUNICATION

4PROGRAM SELECTION

5PROGRAM PRICE AND FEES

6HOW TO PAY

7AUTHORIZATIONS

PARENT/GUARDIAN INFORMATION

Participation in the Junior Sailing Program must be authorized by an adult who has legal responsibility for the child, even if payment will be made by someone else.

Note: For phone numbers, please use the format (207) 555-1212. For States, use the drop-down list. For ZIP Codes, please use the five-digit format, e.g., 04101.

WHO IS REGISTERING THIS SAILOR?*

Parent

Grandparent

Other Relative

Guardian

Honorific*

First Name*

Last Name*

Preferred Phone*

Alternate Phone

Email*

Mailing Address*

City*

State*

ZIP*

Is this sailor*

A child of a PYC Member

A grandchild of a PYC Member

A child of a PYC Applicant on the Waiting List

None of the Above

Name of Member or PYC Membership applicant

Member #

PLEASE LIST TWO CONTACTS IN EVENT OF EMERGENCY (OTHER THAN YOURSELF):

FIRST EMERGENCY OPTION:

Full name*

Relationship to Your Sailor*

Preferred Phone*

Alternate Phone

SECOND EMERGENCY OPTION:

Full name*

Relationship to Your Sailor*

Preferred Phone*

Alternate Phone

COMMUNICATION

Your e-mail address is automatically added to the PYC Junior Sailing mailing list for newsletters and other general communication.

If you would like other family members, guardian or caregiver added to our list, please add their information below.

Please alert those you enter that you have included their email addresses. We are allowed to send mail only to those who are willing to receive it.

Name

E-Mail Address

Name

E-Mail Address

Name

E-Mail Address

Name

E-Mail Address

Name

E-Mail Address

Does Your Family Own a Boat?*

Yes

What type, size, etc.

What kind of boating do you do? (Check all that apply)

Day Boating

Cruising

Racing

Fishing

Other

PROGRAM PRICE AND FEES

Please consult the tables below to determine the price for the program and session(s) you have selected.

Rates are good through April 31. Registration price increases by $20 per session for registrations received after April 31.
A nonrefundable registration fee of $50 is due updon registration.
Use the Member Price rows if the sailor is the child or grandchild of a PYC member or a person on the PYC Waiting List.
There is a special discounted price for full-day Session 1 program.
Use the Non-Member Price rows for all others.
Race Team prices are based on the full 8-week program. Some adjustment will be made for those whose commit is less than the full session.

Members

Session 1 (discounted)	$540.00
1 session other than session 1	$705.00
3 sessions	$1,945.00
4 sessions	$2,430.00
Race Team	$2,430.00
Half Day 1 session	$475.00
Half day-3 sessions	$1,330.00
Half day-4 sessions	$1,645.00
Minnows	$260.00

Non Members

Session 1 (discounted)	$715.00
1 session other than session 1	$815.00
3 sessions	$2,250.00
4 sessions	$2,855.00
Race Team	$2,855.00
Half Day 1 session	$540.00
Half day-3 sessions	$1,490.00
Half day-4 sessions	$1,890.00
Minnows	$285.00

Find the price for the session(s) you have selected.*

HOW TO PAY

PAYMENT BY MEMBERS When your sailor has been confirmed, the Junior Sailing Program fee will be billed to your member account. The charge will appear on your monthly statement. PAYMENT BY NON-MEMBERS You may pay by check or credit card. The link to PLASTIQ to pay securely online by credit card is on our website or call our Sheri Berk, Bookkeeper the contact for payment questions instead of me. NOTE: in addition to the program fee, PLASTIQ charges up to 2.5% for credit card processing. Checks should be made payable to "Portland Yacht Club” and mailed to 40 Old Powerhouse Road, Falmouth, ME 04105. CONSEQUENCE OF LATE PAYMENT If payment is not made on time, you risk losing the registration slot, which could then be filled from our waiting list. No sailor will be allowed to begin the program until payment has been made in full. REFUNDS A complete refund will be granted if the request is made more than four (4) week prior to the program start date. A 50% refund will be granted if the request is made four (4) weeks or less prior to the start of the program. A 25% refund will be granted if the request is made two (2) weeks or less prior to the program start date. No refunds will be granted after the program start date. No refund will be granted if a sailor is dismissed due to behavorial misconduct for violations of safety requirements. In the case of all refunds, PYC will keep $50 to cover the administrative costs. For questions regarding your invoice and payment, please contact Kelley Rich, PYC Club Manager, at (207) 781-9820 Ext. 10, . To withdraw your sailor from the program and request a refund, please contact Junior Program Director junior.director@pycme.net. To be sure you receive your refund in a timely manner, please copy the Club Manager.

I understand and agree to these payment terms.*

Yes

Who is responsible for payment?*

Parent/Guardian Listed Earlier

Different Person

Name of person responsible for Payment

E-mail of person responsible for payment*

Address

Street Address City State / Province / Region ZIP / Postal Code

AUTHORIZATIONS

I authorize the Portland Yacht Club to use photos or video of my child in our brochures, web site, or other material.*

Yes

I certify that all of the information on this registration form is current and correct.

I acknowledge that I have read and understand the mission and purposes of the Junior Sailing Program.

I acknowledge that the Portland Yacht Club may deny entry into the Junior Sailing Program for any reason it deems sufficient. I also understand that the Club may suspend or terminate my child’s participation in the Junior Sailing Program for any violation of the rules of the Program or the rules of the Club.

I authorize the staff and volunteers of the Portland Yacht Club to obtain emergency medical treatment for my child if that should become necessary. I understand that I will be responsible for payment for any such emergency treatment.

I acknowledge that participation in the sport of sailing or in any activity, regatta or event sponsored and/or sanctioned by the Portland Yacht Club Junior Sailing Program may involve substantial risk to my child's body. I hereby waive and release any and all right and claim that I or my child may have against Portland Yacht Club, its ofﬁcers, directors, agents, servants, employees, and members, for any and all injuries suffered by my child arising out of his or her participation in the PYC Junior Sailing Program. This includes traveling to, participating in, or returning from an event sponsored and/or sanctioned by the Junior Sailing Program. I further agree that my child and I will abide by the rules of the Portland Yacht Club while on its premises.

As consideration for the Portland Yacht Clubʼs acceptance of my child to participate in the Junior Sailing Program, I hereby agree to indemnify and hold harmless Portland Yacht Club for any damage which my child, his or her boat, or crew, may cause to any boat or equipment whether owned outright by PYC or leased or borrowed for the Junior Sailing Program. I promise, covenant and agree to be fully liable for all costs and expenses for any and all property damage or loss to both real and/or personal property caused by the intentional or negligent act of my child.

PARENT/GUARDIAN CONFIRMATION By clicking “I understand and agree” below, I signify that I agree to the terms and conditions above. Typing my name in the field below the box is the equivalent of my signature.*

I understand and agree.

Please type your name*

Date Authorized*

Second Parent or Guardian (Optional)

I understand and agree.

Please type your name

Date Authorized

Total Fees

Credit Card

Cardholder Name