Registration Form for Wicklow Sailing Club Junior Training Course 2010  

Member of Wicklow Sailing Club:    Yes  □     No    □     (if No, WSC application to be completed by parent and returned with Junior Membership fee)           

Name of child:                                                         Date of Birth:           ______          

Parent/Guardians Names:  Mother:                                                                                   

                                                Father:                                                                                   

Address:                                                                                                                               

Email address:                                                                                                                     

Contact Numbers:   Home:                     Mobile:                      Work:

Mother:                                               :                                   :                                              

Father:                                                :                                   :                                              

Other:                                                  :                                   :                                              

(You must list a number above where you can be contacted while your child is on the course)

Do you give permission for First Aid to be administered to your child for any minor injuries sustained during the course: Yes             No                                                              

Please detail any medical conditions/illnesses of your child that Wicklow Sailing Club

should be aware of:                                                                                                                                                                                                                                                                                                                                                                                                             

Please tick Current Sailing Level Achieved:

Level 1     □                Level 2    □                Level 3    □     Level 4     □             

Boat Owner:            Yes   □     No   □           Class of Boat:                                                         

Name of  Insurance Co. ____________________________________________

Sail Number:                                                                       Hull Colour:                        

By signing this form, I understand and accept that no liability is attached to Wicklow Sailing Club, its Officers, Members or Servants for any loss or damage to property, or injury sustained by any person enrolled for tuition. I certify that the above boat is insured.

In accordance with ISA requirements, all boats must have a minimum 3^rd Party Marine Liability Insurance of €1,260,000. Please note that Wicklow Sailing Club will not be responsible for the repair or damage to owners’ boats.

Paid:                                       Method:                                              Date: