High School _______________________________________________

Yacht Club Affilation if any___________________ Sail or existing Bow #____

Varsity A: Skipper _______________________________________

Varsity A: Crew _________________________________________

Varsity B: Skipper _____________________________________

Varsity B: Crew _______________________________________

Alternates ____________________________________________

Junior Varsity A: Skipper ________________________________

Junior Varsity A: Crew ____________________________________

Junior Varsity B: Skipper__________________________________

Junior Varsity B: Crew ____________________________________

Alternates ____________________________________

Coach or Parent _________________________________

Phone Number __________________________________

PACIFIC COAST INTERSCHOLASTIC SAILING ASSOCIATION (PCISA), PENINSULA YOUTH SAILING FOUNDATION (PYSF), STANFORD UNIVERSITY, SEQUOIA YACHT CLUB,THE PORT OF REDWOOD CITY AND ALL OFFICERS,EMPLOYEES AND MEMBERS OF SAID ORGANIZATION

I hereby acknowledge that the risk of injury, including serious debilitating injury, or death is involved in the athletic participation.

I am aware that ISSA, PISA, PYSF, Stanford University and Sequoia Yacht Club and The Port of Redwood City do not carry medical or liability Insurance.

I further release and hold harmless ISSA, PCISA, PYSF, Stanford University, The High School Sailing Team, Sequoia Yacht Club,The Port of Redwood City and all Officers, Directors, Trustees Agents, employees, coaches, and all volunteers and members of any of the above from any and all liability arising from any participation in the sport. (Sailing).

Parent /Guardian/__________________________________Date________

Boat #______