PDSC Visiting Sailor Registration

PDSC Visiting Sailor Registration

Please complete this form if you are a visiting sailor intending to sail at Perth Dinghy Sailing Club on a race day.
Date Planning to Sail at PDSC

DayMonthYear
Date
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Post Code
Phone Number

Area CodePhone Number
Current Yacht Club Membership
Name of Yacht Club
Boat Information
Class
Sail #
Boat Name
Do you have a Crew?

YesNo
Crew Details
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Post Code
Phone Number

Area CodePhone Number
Email
example@example.com
Emergency Contacts

Please provide emergency contacts
Skipper Emergency Contact
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to Skipper
Ie Parent, Wife, Husband, Partner
Crew Emergency Contact
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Relationship to Crew
i.e Parent, Wife, Husband, Partner
Any Known Medical Conditions of Skipper/Crew
Please indicate next to condition if this applies to Skipper or Crew
Skipper Signature

Clear
Should be Empty:

Crew Details