Junior Learn to Sail course 2018-19

Youth Learn to Sail Course Registration Form

Course dates and more details are available on our website at https://paremataboatingclub.org.nz/learn-to-sail/
What course would you like to register for? *

October-November 2020 January 2021
Name of Sailor *

First Name Last Name
Birth Date *

Day Month Year
Address *
Name of Parent/Guardian 1 *

First Name Last Name
Name of Parent/Guardian 2

First Name Last Name
Home Phone
Work Phone
Mobile Phone 1
Mobile Phone 2
E-mail 1 *
E-mail 2
Medical conditions & confidence issues the instructors should know about:
Fees: $350 - direct credited to Westpac 03 0547 0016903 00 (incl LTS and Surname as reference)
Date fees were credited

Day Month Year
Are you interested in assisting the instructors during the session in the patrol boats?

Yes No
How did you hear about our course?
Declaration by Parent / Guardian:

I have read the course brief. My child can swim 50 metres and remain in the water for 15 minutes unaided wearing a buoyancy aid and light clothing.

During the course my child will follow all safety instructions given. My child will wear a buoyancy aid at all times when on the water.

I understand that the Paremata Boating Club Inc. does not accept any liability for personal injury or damage or loss of property as a result of my child taking part in this course.
Parent Signature
Date

Day Month Year
Enter the message as it's shown
Please let our secretary know at PBClubSecretary@gmail.com if you don't want your child's photos taken during club's activities to be used for club's purposes (e.g. on club's website, Facebook page, club's promotional activities etc.). Thanks.
Should be Empty:

Youth Learn to Sail Course Registration Form