Youth Sailing Registration

Student Name*
First Last Nickname
Student Birthdate
Health/Other Considerations*
Are there any special needs/allergies/medications/other concerns we need to be aware of?
- Yes
- No
Health/Other Considerations Details*
Fill out any necessary information about Health/Other Considerations here.
Member User ID
If you are already a member of CRSA, please include that here.
Parent Name*
First Last
Parent Relation*
- Mother
- Father
- Guardian
Parent Phone*
Parent Email*
Alternate Contact*
First Last
Alternate Contact Relation*
- Mother
- Father
- Guardian
Alternate Contact Phone*
Alternate Contact Email*
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Permission to Participate and Release of Liability

In consideration of accepting my child's or my entry, I hereby, for myself and my child, waive and release any and all rights and claims for damages my child or I may have against Cave Run Sailing Association Youth Sailing Academy; its principals, directors, officers, agents, employees, volunteers, contributors, donors, their insurers, and each and every land owner, lessee, municipal and/or government agency whose property or equipment is used to conduct any activity for the Cave Run Sailing Association and affiliates, and their insurers, if any, for any and all injuries suffered (including death) by myself or my child at any activity sponsored by these groups.

I acknowledge and understand that the sailing activity I am about to participate in, or let my child participate in, is an exciting and demanding challenge and will expose us to above-normal risks to injury and harm. I agree to assume responsibility for all the risks of the activity for myself and my child.

I grant permission for medical treatment to be administered to my child or myself in the event of an emergency and I assume responsibility for the expense incurred for medical attention throughout the duration of the program.

I allow the use of my child's or my image in future promotional materials produced by Cave Run Sailing Association and/or the CRSA Youth Sailing Academy, for its own behalf.
I have read, understand and agree to the Permissions and Release of Liability*
- Yes
- No
Student Name*
First Last
Parent/Guardian Name*
First Last
Parent/Guardian Signature*

Youth Sailing Student/Parent Agreement
- Parent/Guardian attendance and participation is encouraged! Please make arrangements with the youth director if a student must be unattended.
- Stay with the class unless you have permission from the youth director to leave.
- Life jackets must be worn and secured at all times on dock or boats by all personnel.
- Close-toed shoes should be worn at all times.
- Respect one another - no rough play, violence, or offensive language.
- Respect all property - no destruction or littering on water and land.
- All students must participate in the set-up and take-down and storage of boats.
- Pay attention to overhead tree limbs and wire - stay clear.
- Pay attention to feet and hands/arms between boats, docks and moving parts.
- Use the buddy system - all sailors must sail out and return to docks together.
- All sailors must stay within the hailing distance of the coach boat or shore.
- All sailors and coach boats must return to dock upon notice.
- No swimming per park regulations. No jumping off boats or shore.
- Sailors must make every effort to avoid collisions, or stray from other boats.
I have read, understand and agree to the Student/Parent Agreement*
- Yes
- No
Student Name*
First Last
Student Signature*
Parent Name*
First Last
Parent Signature*
PLEASE NOTE: In case of inclement weather, class cancellation or early dismissal will be at the discretion of the youth director. Students will be notified via parent or guardian email address or phone number. You may also call Chuck @ 859-270-2199 or Kelly @ 859-229-3104.

Youth Sailing Fee*
Total
$ 0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Comments
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