LTS Registration Form
Corpus Christi Yacht Club
Learn to Sail Registration 2017
98 Cooper’s Alley
Corpus Christi, Texas 78401-2899 (361) 883-6518 FAX (361) 883-3121
Name
Sailing Experience: Beginner Intermediate Advanced
Address
Swimming Ability: Beginner Intermediate Advanced
City
Birthday (d/m/y)
Zip code
Entering Grade
Home phone
Health Coverage
Mother’s name
Mother’s daytime phone
Father’s name
Father’s daytime phone
Emergency Contact Person
Emergency Contact #
Age
E-mail address Medical/Health information CCYC staff should be aware of (e.g. allergies, asthma, medications, behavior etc.) How did you hear about our program? *** Please note that after care is intended for pool/swimming time. Lifeguards or responsible for keeping an eye on the child until they are picked up. This does not include extra learn to sail time*** Please Circle desired session
After Care 3:00-4:00 p.m. $75 per week
Cost
Session #1 July 3 - 14
7/3 - 7/7 $75 7/10 - 7/14 $75
$350.00
Session #2 July 17 – July 28
7/17 - 7/21 $75 7/24 - 7/28 $75
$350.00
Session #3 July 31 – August 11
7/31 - 8/4 $75 8/7 - 8/11 $75
$350.00
Session #4 August 14 – August 18
$175.00
8/14 - 8/18 $75
(1-week session only)
Both members and non-members, aged 6 -18
Monday-Friday from 8:30-3:00
Private lessons are available outside sailing school hours. Please contact the Sailing Director for pricing and scheduling.
A discount of 20% will be applied to any individuals signing up for additional sessions after completing a session of 2 weeks.
One week sessions available upon request.
The applicant will not be registered unless the application and WAIVER are fully completed, including PAYMENT IN FULL
No refunds within 2 weeks of the start date
CCYC reserves the right to cancel courses due to insufficient participation
Inquiries, contact Jonathan Atwood Sailing Director at 361-883-6518 or [email protected]
OFFICE USE ONLY *Please do not write anything below* Session # ____
1 week ___________ $175 (Session dates)
Session # ____
1 week ___________ $175 (Session dates)
2 weeks ___________ $350
After Care: 1 week $75
2 weeks $150
After Care: 1 week $75
2 weeks $150
(Session dates)
2 weeks ___________ $350 (Session dates)
TOTAL $ ___________ Payment Method:
Received by ________
Date Received _____________
Cash Check #__________ Credit Card Member #_________
Entered in LTS spreadsheet Entered in CTC on _____________
(Initials)
Page 1 of 2
Program Hours: 8:30 am to 3:00 pm.
After Hours program is available until 4:00 pm at $75 per week. Please note that after care is intended for pool/swimming time. Lifeguards or responsible for keeping an eye on the child until they are picked up. This does not include extra learn to sail time Please provide your child with a life jacket, a sacked lunch, and sunscreen.
Participant Indemnity Waiver I, the parent or guardian or applicant (if over 18), understand and acknowledge that in consideration for accepting the applicant as a student in the Sailing School, the Corpus Christi Yacht Club (CCYC) and the CCYC Sailing School (CCYCSS) will have the right to terminate the student's sailing course without refund should the student fail to comply with the safety rules and rules of conduct which, from time to time, will be set by the Sailing School staff and the Director. Further, I understand that it is a condition of participation in the CCYCSS that I do so at my own risk. Therefore, in consideration of acceptance my application and my being permitted to take part in the program, I agree to save harmless and keep indemnified the CCYC, the CCYCSS and their respective agents, officials, servants and representatives from and against all claims, actions, costs, expenses and demands in respect to death, injury, loss or damage to my person or property, howsoever caused arising out of or in connection with my taking part in the CCYCSS programs, notwithstanding that the same may have been contributed to or caused by or occasioned by the negligence of the same bodies, or any of them, or their agents, officials, servants or representatives. I further understand and agree that this RELEASE is binding upon myself, my heirs, executors and assigns. I agree that core contact information be shared with Texas Sailing, the US Sailing and governments that require statistical information for funding purposes. CCYC, Texas Sailing, or US Sailing will not sell, lease, rent or use this contact information for any commercial purposes.
Name: _____________________________ Signature: ___________________________ Date: _______________________________
Page 2 of 2
Learn to Sail Registration 2017
98 Cooper’s Alley
Corpus Christi, Texas 78401-2899 (361) 883-6518 FAX (361) 883-3121
Name
Sailing Experience: Beginner Intermediate Advanced
Address
Swimming Ability: Beginner Intermediate Advanced
City
Birthday (d/m/y)
Zip code
Entering Grade
Home phone
Health Coverage
Mother’s name
Mother’s daytime phone
Father’s name
Father’s daytime phone
Emergency Contact Person
Emergency Contact #
Age
E-mail address Medical/Health information CCYC staff should be aware of (e.g. allergies, asthma, medications, behavior etc.) How did you hear about our program? *** Please note that after care is intended for pool/swimming time. Lifeguards or responsible for keeping an eye on the child until they are picked up. This does not include extra learn to sail time*** Please Circle desired session
After Care 3:00-4:00 p.m. $75 per week
Cost
Session #1 July 3 - 14
7/3 - 7/7 $75 7/10 - 7/14 $75
$350.00
Session #2 July 17 – July 28
7/17 - 7/21 $75 7/24 - 7/28 $75
$350.00
Session #3 July 31 – August 11
7/31 - 8/4 $75 8/7 - 8/11 $75
$350.00
Session #4 August 14 – August 18
$175.00
8/14 - 8/18 $75
(1-week session only)
Both members and non-members, aged 6 -18
Monday-Friday from 8:30-3:00
Private lessons are available outside sailing school hours. Please contact the Sailing Director for pricing and scheduling.
A discount of 20% will be applied to any individuals signing up for additional sessions after completing a session of 2 weeks.
One week sessions available upon request.
The applicant will not be registered unless the application and WAIVER are fully completed, including PAYMENT IN FULL
No refunds within 2 weeks of the start date
CCYC reserves the right to cancel courses due to insufficient participation
Inquiries, contact Jonathan Atwood Sailing Director at 361-883-6518 or [email protected]
OFFICE USE ONLY *Please do not write anything below* Session # ____
1 week ___________ $175 (Session dates)
Session # ____
1 week ___________ $175 (Session dates)
2 weeks ___________ $350
After Care: 1 week $75
2 weeks $150
After Care: 1 week $75
2 weeks $150
(Session dates)
2 weeks ___________ $350 (Session dates)
TOTAL $ ___________ Payment Method:
Received by ________
Date Received _____________
Cash Check #__________ Credit Card Member #_________
Entered in LTS spreadsheet Entered in CTC on _____________
(Initials)
Page 1 of 2
Program Hours: 8:30 am to 3:00 pm.
After Hours program is available until 4:00 pm at $75 per week. Please note that after care is intended for pool/swimming time. Lifeguards or responsible for keeping an eye on the child until they are picked up. This does not include extra learn to sail time Please provide your child with a life jacket, a sacked lunch, and sunscreen.
Participant Indemnity Waiver I, the parent or guardian or applicant (if over 18), understand and acknowledge that in consideration for accepting the applicant as a student in the Sailing School, the Corpus Christi Yacht Club (CCYC) and the CCYC Sailing School (CCYCSS) will have the right to terminate the student's sailing course without refund should the student fail to comply with the safety rules and rules of conduct which, from time to time, will be set by the Sailing School staff and the Director. Further, I understand that it is a condition of participation in the CCYCSS that I do so at my own risk. Therefore, in consideration of acceptance my application and my being permitted to take part in the program, I agree to save harmless and keep indemnified the CCYC, the CCYCSS and their respective agents, officials, servants and representatives from and against all claims, actions, costs, expenses and demands in respect to death, injury, loss or damage to my person or property, howsoever caused arising out of or in connection with my taking part in the CCYCSS programs, notwithstanding that the same may have been contributed to or caused by or occasioned by the negligence of the same bodies, or any of them, or their agents, officials, servants or representatives. I further understand and agree that this RELEASE is binding upon myself, my heirs, executors and assigns. I agree that core contact information be shared with Texas Sailing, the US Sailing and governments that require statistical information for funding purposes. CCYC, Texas Sailing, or US Sailing will not sell, lease, rent or use this contact information for any commercial purposes.
Name: _____________________________ Signature: ___________________________ Date: _______________________________
Page 2 of 2
