Sail Martha's Vineyard

SAIL MV SUMMER 2012 REGISTRATION

P.O Box 1998, 110 Main St, Vineyard Haven, MA, 02568, 508-696-7644 Office, 508-696-7868 Fax
sail_mv@verizon.net www.sailmv.com

 

All participants must be members of SMV


SMV must have on file a current physical & immunization record from your doctor for all participants

 

Fees: $50 per student required for all students or $150 Family membership
Messing in Boats I & II: No program fee for Island students, $300 for Seasonal Residents
Novice Opti: No program fee for Island students, $450 for Seasonal Residents
Intro Sloops: No program fee for Island students, $450 for Seasonal Residents
Int. & Adv. Opti, Int. Sloop & Performance Sloops, 420's & Windsurfing: $200 for Island students, $450 for Seasonal Residents
Limited scholarships are available

SAILOR INFORMATION
First Name*: A value is required. Last Name*: A value is required. MI
Date of Birth* A value is required. School: Grade:
Weight*: A value is required. Height*: A value is required. Age*: A value is required.
Email:        
Can you pass a swim test? Yes No
Have you completed a Sail MV or other Sailing Course? Yes No

PARENT INFORMATION
Father's Name Mailing: Email:

Phone

(include cell #)

 Occupation:    
Mother's Name: Mailing: Email:
Phone
(include cell #)		 Occupation:    
PARENT'S COMMITMENT: This program requires my commitment to help make it happen. I promise a minimum of 8 hours of help. Please make a selection.

PART II: SAIL MV CLASS/SESSION CHOICES
MESSING AROUND IN BOATS I
Ages: 8 & 9
Time: M-F 9-Noon
Next Class: Messing II or Novice Opti 		6/25-6/29 7/02-7/06 7/09-7/13 7/16-7/20
MESSING AROUND IN BOATS I (CONT.)
Ages: 8 & 9
Time: 9am-Noon
Prerequisite: None
Next Class: Messing II or Novice Opti 		7/23-7/27 7/30-8/03 8/06-8/11
MESSING AROUND IN BOATS II
Ages: 8 & 9
Time: M-F 9-Noon
Next Class: Novice Opti 		6/25-6/29 7/02-7/06 7/09-7/13 7/16-7/20
MESSING AROUND IN BOATS II (cont.)
Ages: 8 & 9
Time: 9am-Noon
Prerequisite: None
Next Class: Novice Opti 		7/23-7/27 7/30-8/03 8/06-8/11 8/13-8/17
NOVICE OPTI
Ages: 10-12
Time: M-F 9-Noon
Prerequisite: None
Next Class: Intermediate Opti 		6/25-7/06 7/09-7/20 7/23-8/03 8/06-8/17
INTERMEDIATE OPTI
Ages: 11-13
Time: M-F 1pm-4pm
Prerequisite: Novice Opti or recommendation from SMV Instructor
 6/25-7/06 7/09-7/20 7/23-8/03 8/06-8/17
ADVANCED OPTI
Ages: 11-15
Time: M-F 1pm-4pm
Prerequisite: Recommendation from SMV Instructor
 6/25-7/06 7/09-7/20 7/23-8/03 8/06-8/17
NOVICE SLOOP
Ages: 11-16
Time: M-F 9-Noon
Next Class: INT/SLOOPS 		6/25-7/06 7/09-7/20 7/23-8/03 8/06-8/17
INTERMEDIATE SLOOP
Ages: 12-18
Time: M-Th 1pm-4pm
Prerequisite: Intro Sloop or recommendation from SMV Instructor
 6/25-7/06 7/09-7/20 7/23-8/03 8/06-8/17
PERFORMANCE SLOOPS
Ages: 13-18
Time: 1pm-4pm
Prerequisite: INT.OPTI or INT.SLOOPS
 6/25-7/06 7/09-7/20 7/23-8/03 8/06-8/17
420's
Ages: 13-18
Time: 1-4 pm
Prerequisite: Intermediate class
 6/25-7/06 7/09-7/20 7/23-8/03 8/06-8/17
INTRO WINDSURFING
Ages: 12-18
Time: M- F 9-Noon
Prerequisite: None
 6/25-7/06 7/09-7/20 7/23-8/03 8/06-8/17
INT/ADV. WINDSURFING
Time: M-F 1-4 pm
Prerequisite: Instructor recommendation
 7/09-7/20 7/23-8/03 8/06-8/17
ADVANCED 420 RACE TRAINING
Time: M & W 4-7pm
Prerequisite: Instructor recommendation
 7/09-7/18 8/06-8/15
VOLUNTEER OPPORTUNITIES
 Boat Day Seafood Buffet & Auction 7/07 Vineyard Cup Regatta Weekend 7/13-15 Office Help

MEDICAL AND EMERGENCY INFORMATION

 
Physical handicaps:
Please check those that apply: (provide necessary details below)

CHRONIC AILMENTS

  

ALLERGIES

  
ASTHMA, OR OTHER RESPIRATORY PROBLEMS MEDICATION
DIABETES OR HYPOGLYCEMIA BEE STINGS/INSECT BITES
HEMOPHILIA, OR OTHER BLEEDING PROBLEMS FOODS
CIRCULATORY OR HEART PROBLEMS OTHER, IF SIGNIFICANT
EPILEPSY    

Details:

Date of last tetanus shot*: A value is required.
Current medications, if any:
PHYSICIAN'S NAME* A value is required. PHYSICIAN'S PHONE A value is required.
DATE OF LAST EXAM* A value is required.  
HEALTH INSURANCE CARRIER* A value is required. INSURANCE ID NUMBER* A value is required.

CONSENT FOR MEDICAL TREATMENT (MINOR)

As parent or legal guardian of the above-named participant, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions necessary to preserve life, limb or well being of my dependent.
Please make a selection.please check to indicate permission
Type your name as your signature: A value is required. Date:

WAIVER OF LIABILITY:

I, the parent/guardian of the participant agree that I and the participant will release, discharge and/or otherwise indemnify Sail Martha’s Vineyard, its affiliated personnel, including owners of the boats and facilities used for the Program, against any claims by or on behalf of the participant as a result of the participants activities in the program and/or while being transported to or from the same, which transportation I hereby authorize.

 

Please make a selection.please check to indicate permission

Type your name as your signature: A value is required. Date:
IN CASE OF EMERGENCY CALL:
Contact Name 1: A value is required. Relationship: A value is required. Phone: A value is required.
Contact Name 2: Relationship: Phone:
To prevent spammers from using this form please enter the validation numbers that you see on the right (you need to have cookies enabled):   
Parent, please type your name as your signature: A value is required. Date:
 
 
 
 
 

 

Sail Martha's Vineyard is a non-profit organization dedicated to celebrating and protecting the island's maritime heritage.Sail Martha's Vineyard is a non-profit organization dedicated to celebrating and protecting the island's maritime heritage.