PERSONAL INFORMATION (You may only sign up one sailor at a time)
*Student First Name:
*Student Last Name:
*Street Address:
*City:
*State:
*Zip Code:
Student's Email:
*Student's Birth Date:
*Parent 1 Name:
*Cell Phone 1:
*Parent Email:
*Home Phone 1:
Parent 2 Name:
Cell Phone 2:
Home Phone 2:
MEDICAL LIABILITY WAIVER
A Parent or Legal Guardian must Read and Agree to the Medical Liability Agreement and complete the following information:
Emergency Contact Name:
Daytime Phone:
Cell Phone:
Insurance Provider:
Medical Concerns / Known Allergies:
I HAVE CAREFULLY READ THE MEDICAL AND LIABILITY AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THE AGREEMENT INCLUDES A WAIVER OF LIABILITY, AN ASSUMPTION OF RISK, AND AN AGREEMENT BY ME TO INDEMNIFY THE RELEASEES, AND I AGREE TO IT OF MY OWN FREE WILL.
PAYMENT INFORMATION

Name on Credit Card:

San Diego Yacht Club utilizes Google Checkout to process credit card payments for online regatta entries. This process will ensure the user a secure and expeditious method of payment with the latest in secure online transactions. You will be prompted to complete this process once you SUBMIT this form.