| Premier Sailing School Application Form- Keelboat Sailing Course To Print a copy of this form - Right Click here and Choose "Print" Name......................................................................... E-Mail............................................................ Address......................................................................................................................................................... ................................................................................... Can you Swim? Yes....................No ............... Telephone Home.........................................Work........................................Cell.......................................... Where/How did you hear about us ?............................................................................................................. Medical Condition. If you have a medical condition that you think we should be aware of, for your safety, please state below. ( This information will be kept in confidence)........................................................................................................................................................................ Next of Kin. Please provide Name & Phone No. of person we can contact in case of accident or emergency.
Course Booked. ( please check appropriate course).
Course Dates Requested............................................................................................................................... Total Fee $....................... Deposit ($100)Enclosed ........................ Full Payment Enclosed $.................................................................... Checks Payable to Premier Sailing- Deposit should be sent with this booking form-Balance Due 30 days in advance. Send to - PO Box 779, Irvington, Virginia 22480 - telephone 804 438 9300 -Email info@premiersailing.com |
| Waiver - Sailing Instruction and release of liability and assumption of risk agreement. The undersigned Premier Sailing School customer or guardian assumes and understands that sailing is a potentially hazardous sport; that grounding, accidental jibes, manoverboards, and equipment failures occur from time to time without warning, and that variations in wind and sea conditions, water traffic, submerged obstructions, and other hazards to navigation exist. In using Premier Sailing School's equipment, or participating in sailing instruction, or sailing events at Premier Sailing School, the undersigned recognizes and accepts such dangers and assumes full responsibility for such risks and hold Premier Sailing School and /or their officers, employees, assistants or agents harmless against any and all bodily injury and/or property damages resulting from such risks. The undersigned expressly acknowledges the New Tides LLC. and related parties, have no responsibility whatsoever for sailing school activities. |
| Signed................................................................... Date......................................................... |