Junior Learn to Sail Application Form

Course applied for* (please tick):

Participant's information

Name of participant*
Name of parent/guardian*
Relationship to participant*
Address*
Date of birth*
Age*
School*
Phone*
Mobile*
Email*

In case of emergency please contact:

Name*
Relationship*
Telephone*
Mobile*
How did you hear about us?
Please detail any conditions your child suffers from that the organizers need to be aware of and include specific actions to be taken in regard to the conditions.
I agree to*

1. release the delegation to staff, officers or volunteers of the Brighton & Seacliff Yacht Club to take whatever prudent measures they feel necessary to ensure the well-being of my child in an emergency and I agree to meet any costs of such action.

2. waive and release all right or claim for damages I, my heirs, executors and administrators may have against the Brighton & Seacliff Yacht Club for any damages that my child may sustain during the course.

3. Comply with any/all policies and procedures of the Brighton & Seacliff Yacht Club.

4. I understand and accept the risks involved with sailing at this location and declare that my child is fit and able to take part in all activities. I have given accurate medical information above as required.

Use of Photographs

I give permission for BSYC to use photographs of the participant to promote BSYC and the BSYC Sailing and Aquatics School.

Payment Details* (please tick)

Registration Fee ($240)
YA Certificate ($11) (certificate will be sent to the address you have provided once the course is completed)
TOTAL: $0

PAYMENT OPTIONS*

1. Cheque: All cheques to be made payable to BRIGHTON AND SEACLIFF YACHT CLUB.
2. Electronic Funds Transfer: Please remit funds to:
Account: Brighton and Seacliff Yacht Club, BSB 015-209, Account number 2579 16874. Please record your reference details here
3. Credit Card Authority:

Payable direct to: Brighton and Seacliff Yacht Club
Please debit the amount payable to my charge account

Card type:
Card Number :
Expiry Date : Month Year
Name on Card :
Amount payable : $0

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246 Esplanade SEACLIFF SA 5049 Telephone: (08) 8296 7935