Student Name
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First Name
Last Name
School grade completed as of June
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Previous Sailing Experience
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Parent / Guardian Name
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First Name
Last Name
Primary Phone
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(###)
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Email
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Address
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Local Emergency Contact (Name & Phone)
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Secondary Emergency Contact (Name & Phone)
Summer Sessions
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Please select all that apply. Students may sign up for multiple courses if course prerequisites are met.
If your session is full, can you be flexible with dates?
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If yes, specify second preferred date
Please specify all individuals who have permission to pick up your child(ren).
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The following rules apply to all Middle Keys Sailing students.
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1. No students on docks without supervision and a life jacket and shoes
2. Life jackets must be worn and secured at all times on docks, piers, boats, or in the water (by students, instructors, and coaches)
3. Face coverings must be worn at all times except when on boats and in the water; one student per sailboat except siblings, and all must maintain three feet of social distancing at all times
4. Closed toed footwear to be worn at all times
5. No running
6. No swimming (except with the permission of the instructors)
7. No jumping off boats (except with the permission of the instructors)
8. Respect one another—no hitting, pushing, or roughhousing
9. Use respectful language—no swearing, foul, or rude language
10. No littering on land or water
11. Stay with the class unless you have permission from an instructor to leave
12. All sailors must make an effort to sail out and return to docks together or with a buddy
13. Prior to drills, all boats must stay within hailing distance of the safety/coach boat
14. All coach boats and junior sailboats must return to the dock prior to sunset
15. No destruction of club or private property
16. No smoking, drugs, or alcohol
17. No playing on or near ramps and hoists
18. No playing with boom, hoist, or crane
19. Watch fingers and feet between boats, docks, and moving parts
20. Check for overhead wires in boat storage and launching areas
21. Club-owned boats must be properly returned and put away after use
22. Sailors must make every effort to avoid collisions
We, the undersigned being an applicant for admission to the Middle Keys Sailing Program and a parent/ guardian of the applicant, do hereby acknowledge that participation in the Sailing Program poses certain inherent risks which cannot be avoided and acknowledge that we are accepting those risks.
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In consideration of the acceptance of applicant’s application, we release and forever discharge the Middle Keys Sailing Program, the MYCEF Educational Program, its Officers, its Board of Directors, its Sailing Committee, their servants, agents, and employees, from any claim for property damage, injury or death arising out of or during the course of any participation in the Middle Keys Sailing Program. We represent that we have and will maintain sufficient coverage under our homeowner’s or tenant’s liability insurance policy for any negligent acts of applicant in his/her pursuance of school activities. We further certify that, to the best of our knowledge, the applicant is in good physical condition and suffers from no physical, emotional or mental impairment, which would adversely affect his/her ability to safely participate in sailing activities. I also agree to the use of photographs of my child in Middle Keys Sailing and MYCEF Educational Foundation's digital and print marketing, education, fundraising, and publication efforts.
Image Release
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I grant permission to Middle Keys Sailing, its employees and agents, to take and use visual/audio images of me. Visual/audio images are any type of recording, including photographs, digital images, drawings, renderings, voices, sounds, video recordings, audio clips or accompanying
written descriptions. I agree that Middle Keys Sailing owns the images and all rights related to them. The images may be used in any manner, media, or social media without notifying me, such as web sites, social sites, publications, promotions, broadcasts, advertisements, posters and theater slides, as well as any other uses by Middle Keys Sailing. I waive any right to inspect or approve the finished images or any printed or electronic matter that may be used with them.
I release Middle Keys Sailing and its employees and agents, including any firm authorized to publish and/or distribute a finished product containing the images, from any claims, damages or liability which I may ever have in connection with the taking of use of the images or printed material used with the images.
Student Name
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Date of Birth
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MM
DD
YYYY
Sex
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Height
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Weight
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Any past medical problems?
Has the student ever had any surgeries? Please list.
Does the student have any known allergies?
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Please list any allergies to mediations, foods, or others including bees, wasps, jellyfish, etc.
Please list any current medications.
Last Tetanus Shot:
Physician’s Name
Physician’s Telephone
(###)
###
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Has the student received a recent physical examination (within 24 months of program start date)?
Medical Release
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Electronic Parent/Guardian Signature
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Electronic Student Signature
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