SILVER FLEETCHAMPIONSHIP REGATTA
To be held at
(South Bay-San Diego )
Hosted by
The CoronadoYacht Club
APRIL 12 - 13,2002
Parent's Consent and Waiver of Liability,
Assumption of Risk & IndemnityAgreement
Sailorname: ______________________________
HighSchool: ______________________________
Theundersigned parents or legal guardians (hereafter referred to in the
singular)of the above named child (the "Sailor"), request that the
Sailor beallowed to participate at the Silver Fleet Championship Regatta, (the
Silver "PCCs"), at South Bay, San Diego , California, and at
otherlocations including The CoronadoYacht Club, Coronado, California.
Thisagreement shall remain in effect until the end of the activities
describedabove.
TheSilver PCCs are being run under the auspices of the Pacific
CoastInterscholastic Sailing Association (“PCISA”), is hosted by The Coronado
YachtClub (“CorYC”) and at facilities provided by CoronadoYC. These entities
are collectively referred toherein as Regatta Providers (“RP”).
Inreturn for the Sailor being permitted to take part in the activities and to
usethe facilities and property associated with the Silver PCCs, each of us
makesthe following promises and warrants the truth of the following facts:
1) I am familiarwith yacht racing and regatta activities, and I understand
officers, membersand employees of RP are available to discuss the activities if
I should wishadditional information. I alsounderstand I am solely responsible
for the transportation to and from theregatta, and the arrival and departure of
the Sailor at the beginning and endof each day's activity. I will notallow the
Sailor to attend the regatta without appropriate supervision. I agree that the
RP will have noresponsibility for the direct supervision of the Sailor. The
Adult Team LeaderChaperone named on the Regatta Entry Form and/or I/we, if
present, will beresponsible for the Sailor. I will inform the Sailor that he/she
is expected tocooperate with, and follow the directions of the Adult Team Leader
Chaperoneand persons in charge of the activities and to act in a manner
consistent withthe spirit of good sportsmanship, the regatta rules and respect
for the rightsof others.
2) CONSENT The Sailor is in good health,and I know of no reason why
he/she would be incapable of participating in theactivities. I consent to the
Sailor’s participation in the regatta. The Sailor knows how to swim. I will
immediately notify the designated RPCommittee at the regatta site if a change in
the Sailor’s health or othercondition would affect the Sailor’s ability to
participate in the activities.
3) WAIVER OF LIABILITY I waive andrelease any right I, the Sailor, my
heirs, distributees, guardians, legalrepresentatives 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 tothe Sailor or damage to the property of the
Sailor or myself arising from theSailor’s participation in the activities and
use of the facilities and propertyof any RP whether or not the injury or damage
results from the negligence or otheraction, except intentional acts, of any of
the Releases. (Myinitials indicate that I have read this paragraph. ______)
4) ASSUMPTION OR RISK I am aware thatthe activities will involve
maneuvering and being on a boat or other watercrafton deep waters in potentially
hazardous conditions which may include, amongother things, strong and high winds
and tides or currents, sudden andunexpected immersion in deep waters and
collision with other watercraft orstationary objects such as docks, pilings and
buoys. With knowledge of the dangers involved, I voluntarily ask thatthe 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 THEUSE OF THE FACILITIES AND PROPERTY OF ANY
RP, WHETHER OR NOT CAUSED BY THENEGLIGENCE OR OTHER ACTION, EXCEPT INTENTIONAL
ACTS, OF ANY OF THE RELEASES. (Myinitials indicate that I have read this
paragraph. ______)
5) INDEMNITY AGREEMENT I agree toindemnify and hold the Releases
harmless from any loss, liability, damage orcost, including reasonable attorneys
fees, they may incur due to the Sailor’sparticipation in the activities and use
whether or not such loss, liability,damage or cost results from the negligence
or other action, except intentionalacts, of any of the Releases. (Myinitials
indicate that I have read this paragraph. ______)
IHAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM
AWARE THE AGREEMENT INCLUDES A WAIVEROF LIABILITY, AN ASSUMPTION OF RISK AND AN
AGREEMENT BY ME TO INDEMNIFY THERELEASES, 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: __________________________________________
PLEASE NOTE:
Every participant team member must havethis form properly filled out, signed
and in the hand of the regatta committee in order to sail orparticipate. Make
copies of this form asneeded for each participant team member.
Silver PCCs MEDICAL RELEASE INFORMATION
School:________________________________________________________________________
List all known allergies tomedications:________________________________________
Date of last tetanus shot:_____________Current medications:____________________
Medical Insurance Information:
Father’sInsurance Coverage
Mother’sInsurance Coverage:
Carrier:_____________________________________Carrier:__________________________________________
Policy#: ___________ Group#: ________________Policy#:
_____________Group#:__________________
Asthe parent/guardian of the above named student, I hereby acknowledge that
therisk of injury, including serious debilitating injury, is involved in
athleticparticipation. I recognize that PCISA, and The Coronado Yacht Club and
theirrepresentatives make efforts to reduce these risks, but further recognize
thattheir efforts cannot and will not eliminate all such risks. I am aware of
the risks involved, and givemy consent for the above named student to
participate in all activitiesassociated with the Silver PCCs.
I am aware that PCISA and The Coronado Yacht Club do not carry medical insurance
forparticipants in this regatta and that medical insurance coverage will
beprovided by parent/guardian. Evidenceof such coverage is provided above.
I further release andhold harmless PCISA, TheCoronado Yacht Club, their
Officers, Directors, Trustees, agents, employees,coaches and athletic trainers
from any and all liability arising from theabove-named student’s participation
in the Silver PCCs and all relatedactivities.
In addition to the above, I hereby grant permission toany appropriately
qualified health care professional to give any and all medicallyappropriate
emergency care to my son/daughter/ward, including but not limitedto anesthesia
and surgery.
____________________________________________
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Father/LegalGuardian Date Mother/Legal Guardian
Date
____________________________________________ ___________________________________________
Address Address
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City State Zip
City State Zip
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Home telephone Work telephone Home telephone
Work telephone