PCISA HIGH SCHOOL PACIFIC COAST
DOUBLE HANDED CHAMPIONSHIP REGATTA
for the
WAKEMAN TROPHY
To be held at
Treasure Island
Sailing Center
San Francisco Bay, California
Hosted by
The San Francisco Yacht Club
APRIL 20 - 21, 2002
Parent's Consent and Waiver of Liability,
Assumption of Risk & Indemnity Agreement
Sailor name:
______________________________
High School:
______________________________
The undersigned parents or legal guardians (hereafter referred to in the singular) of the above named child (the "Sailor"), request that the Sailor be allowed to participate at Pacific Coast Interscholastic Sailing Association Pacific Coast Double Handed Championship Regatta, (the "PCCs"), at Treasure Island Sailing Center, San Francisco, California, and at other locations including The San Francisco Yacht Club, Belvedere, California.
This agreement shall remain in effect until the end of the activities described above.
The PCCs are being run under
the auspices of the Interscholastic Sailing Association (“ISSA”), the Pacific
Coast Interscholastic Sailing Association (“PCISA”), is hosted by The San
Francisco Yacht Club (“SFYC”) and at facilities provided by SFYC and the
Treasure Island Sailing Center (“TISC”) (a facility managed by the Treasure
Island Sailing foundation (“TISF”)).
These entities are collectively referred to herein as Regatta Providers
(“RP”).
In return for the Sailor
being permitted to take part in the activities and to use the facilities and
property associated with the PCCs, each of us makes the following promises and
warrants the truth of the following facts:
1) I am familiar with yacht racing and regatta activities, and I understand officers, members and employees of RP are available to discuss the activities if I should wish additional information. I also understand I am solely responsible for the transportation to and from the regatta, and the arrival and departure of the Sailor at the beginning and end of each day's activity. I will not allow the Sailor to attend the regatta without appropriate supervision. I agree that the RP will have no responsibility for the direct supervision of the Sailor. The Adult Team Leader Chaperone named on the Regatta Entry Form and/or I/we, if present, will be responsible for the Sailor. I will inform the Sailor that he/she is expected to cooperate with, and follow the directions of the Adult Team Leader Chaperone and persons in charge of the activities and to act in a manner consistent with the spirit of good sportsmanship, the regatta rules and respect for the rights of others.
2) CONSENT The Sailor is in good health, and I know of no
reason why he/she would be incapable of participating in the activities. I
consent to the Sailor’s participation in the regatta. The Sailor knows how to swim.
I will immediately notify the designated RP Committee at the regatta
site if a change in the Sailor’s health or other condition would effect the
Sailor’s ability to participate in the activities.
3) WAIVER OF LIABILITY I waive and release any right I, the
Sailor, my heirs, distributees, guardians, legal representatives and assigns
may have or acquire to make a claim against, sue, attach the property of or
prosecute any RP or its members, directors, trustees, officers, volunteers,
agents, employees and affiliated organizations or persons ("the
Releases") for monetary or other damages caused by injury to the Sailor or
damage to the property of the Sailor or myself arising from the Sailor’s
participation in the activities and use of the facilities and property of any
RP whether or not the injury or damage results from the negligence or other
action, except intentional acts, of any of the Releases. (My
initial’s indicate that I have read this paragraph. ______)
4) ASSUMPTION OR RISK I am aware that the activities will
involve maneuvering and being on a boat or other watercraft on deep waters in
potentially hazardous conditions which may include, among other things, strong
and high winds and tides or currents, sudden and unexpected immersion in deep
waters and collision with other watercraft or stationary objects such as docks,
pilings and buoys. With knowledge of
the dangers involved, I voluntarily ask that the Sailor be allowed to take part
in the activities. I ACCEPT ANY AND
ALL RISKS TO MYSELF AND THE SAILOR OF INJURY, DEATH AND PROPERTY DAMAGE ARISING
FROM PARTICIPATION IN THE ACTIVITIES AND THE USE OF THE FACILITIES AND PROPERTY
OF ANY RP, WHETHER OR NOT CAUSED BY THE NEGLIGENCE OR OTHER ACTION, EXCEPT
INTENTIONAL ACTS, OF ANY OF THE RELEASES.
(My initials indicate that I have
read this paragraph. ______)
5) INDEMNITY AGREEMENT I agree to indemnify and hold the
Releases harmless from any loss, liability, damage or cost, including
reasonable attorneys fees, they may incur due to the Sailor’s participation in
the activities and use whether or not such loss, liability, damage or cost
results from the negligence or other action, except intentional acts, of any of
the Releases. (My initials indicate that
I have read this paragraph. ______)
I HAVE CAREFULLY READ THIS 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 RELEASES, AND I SIGN IT OF MY OWN FREE WILL.
|
DATE
:________________________________________________________ SAILOR’S SIGNATURE:
________________________________________ PRINT NAME:
_________________________________________________ PARENT/GUARDIAN SIGNATURE:
______________________________ PRINT NAME:
_________________________________________________ PARENT/GUARDIAN SIGNATURE:
______________________________ PRINT NAME:
_________________________________________________ ADDRESS:
____________________________________________________ ____________________________________________________ TELEPHONE:
________________________________________________ SCHOOL: __________________________________________ |
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PLEASE NOTE:
Every participant team member must have
this form properly filled out, signed and in the hand of the regatta committee in order to sail or
participate. Make copies of this form
as needed for each participant team member.
PCCs MEDICAL RELEASE INFORMATION
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 PCCs.
I
am aware that ISSA, PCISA, Treasure Island Sailing Foundation and The San
Francisco Yacht Club do not carry medical insurance for participants in this
regatta 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 PCCs and all related activities.
In addition to the above, 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
____________________________________________
___________________________________________
____________________________________________
___________________________________________
City State Zip City State Zip
____________________________________________
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