PARENT CONSENT, WAIVER OF LIABILITY

AND MEDICAL RELEASE

 

INTERSCHOLASTIC SAILING ASSOCIATION (ISSA),

PACIFIC COAST INTERSCHOLASTIC SAILING ASSOCIATION (PCISA),

TREASURE ISLAND SAILING FOUNDATION

AND THE SAN FRANCISCO YACHT CLUB

 

CRESSY ELIMINATION REGATTA

 

 

Student’s Name: __________________________________________________________

Date of Birth:  _____________________            School: _____________________________

 

List all known allergies to medications: _____________________________________________________

Date of last tetanus shot: ___________________  Current medications: _________________________

 

Medical Insurance Information:

                Father’s Insurance Coverage                                               Mother’s Insurance Coverage:

 

Carrier: _____________________________________      Carrier:                _______________________________________

Policy #: ___________  Group #: ________________                Policy #: _____________  Group #: __________________

 

As the parent/guardian of the above named student, I hereby acknowledge that the risk of injury, including serious debilitating injury, is involved in athletic participation.  I recognize that ISSA, PCISA, Treasure Island Sailing Foundation and The San Francisco Yacht Club and their representatives make efforts to reduce these risks, but further recognize that their efforts cannot and will not eliminate all such risks.  I am aware of the risks involved, and give my consent for the above named student to participate in all activities associated with the Cressy elimination regatta.

 

I am aware that ISSA, PCISA, Treasure Island Sailing Foundation and The San Francisco Yacht Club do not carry medical insurance for students and that medical insurance coverage will be provided by parent/guardian.  Evidence of such coverage is provided above.

 

I further release and hold harmless ISSA, PCISA, Treasure Island Sailing Foundation, The San Francisco Yacht Club, their Officers, Directors, Trustees, agents, employees, coaches and athletic trainers from any and all liability arising from the above-named student’s participation in the Cressy elimination regatta and all related activities.

 

PERMISSION FOR MEDICAL CARE

 

I hereby grant permission to any appropriately qualified health care professional to give any and all medically appropriate emergency care to my son/daughter/ward, including but not limited to anesthesia and surgery.

 

____________________________________________               ___________________________________________

Father/Legal Guardian                                 Date               Mother/Legal Guardian                                     Date

____________________________________________              ___________________________________________

Address                                                                                          Address

____________________________________________               ___________________________________________

City                                         State                           Zip                City                                               State                       Zip

____________________________________________               ___________________________________________

Home telephone                              Work telephone             Home telephone                    Work telephone

2001 CRESSY ELIMINATION REGATTA

The San Francisco Yacht Club

September 29-30, 2001

 

 

School:                 ________________________                 Coach:                             ______________________

Captain:                 ________________________                 Day Phone:                 ______________________

Address:                 ________________________                 Eve Phone:                 ______________________

City:                 ________________________                 State: _____   Zip: ________

 

Team Information:

 

Sailor Name:                                                                     Year                                         DOB

________________________________________________________________________ 

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

 

 

 

Entry Fees: $15.00 per sailor  x  __________ sailors                                                 $___________

 

Please make checks payable to:  The San Francisco Yacht Club

 

 

Team Captain Signature: ______________________________                 Date: _____________

 

Return to:

 

The San Francisco Yacht Club

Attn: Quentin Pollock/Cressy Eliminations

P.O. Box 379

Belvedere, CA  94920

 

or via fax at 415-435-8547