I give permission for my child, ____________________________________________, to participate in the IYC Youth Sailing Program and Recreation Program and to go on all Youth Sailing and Recreation excursions during the months of June, July, and August. I agree to indemnify and hold harmless the instructors and leaders of these programs, the Inverness Yacht Club and its Officers, Directors and Employees, and absolve them of any responsibility should an injury occur to my child, notwithstanding any fault or neglect of any of them. I further agree to be responsible for and promptly reimburse the IYC for any damage that may be done to IYC boats or facilities used by my child or children.
 
I further give permission for my child to receive medical treatment from any licensed physician in the event of an emergency.
 
My child, ___________________, has the following allergies, medical or special learning conditions:

______________________________________________

______________________________________________

In case of emergency, please notify:

Name: ________________________________________

Phone: ________________________________________

Name: ________________________________________

Phone: ________________________________________

I understand that acceptance of my child as a student in the Youth Sailing and Recreation Program of the Inverness Yacht Club is subject to:
[a] Space availability.
[b] The demonstrated ability of the student to pass a swimming qualification.
[c] The requirement that the student must provide and wear a Coast Guard approved Type III life jacket.
[d] The requirement that the student provide and wear a wet suit and closed toed shoes.
[e] The student following the direction of the Program Instructors and Staff.
[f] The understanding that drugs, alcohol or cigarettes brought on to the Club's property or to any Youth Sailing activity will result in dismissal.









Date: _________________________________________


Applicant Name: ________________________________

Applicant Signature: _____________________________


Parent/Guardian Name: __________________________

Parent/Guardian Signature: _______________________