Sail Connecticut Access Program

	Sail Connecticut Access Program Sailing Opportunities for Persons with Special Needs

Welcome

Membership Sailing Days

Become A Member

Participants

Pictures

Links

Support Us / Fundraising

Now is the time to come aboard! Sail Connecticut Access Program is open to all individuals and groups interested in sailing opportunities for persons with special needs. Don't put it off - Print and fill out the information below and set sail with us!

Yes, I would like to become a member and / or support the Sail CT access Program for the 20__ season .

We are a not for profit, 501 (C) (3) organization. Donations are deductible to the extent allowed by law.

Individual & family $40¹
Volunteers & family $40²
Captain's Table $100
Commodore's Club $150
Corporate Sponsor $250
Admiral's Circle $500
Organizations/ 1 boat/week $350
Organizations/ 2 boat/week $600
Organizations/ 3 boat/week $900
Other (Your donation is greatly appreciated, thank you)	$________
your logo on our sail:	Call Us!

1:Fee will be waved on request due to financial hardship.
2: Able bodied volunteers are expected to vounteer as mates, skippers or dock hands and may use the boats, when available, provided a qualified skipper is at the helm.

Please make checks payable to: Sail Connecticut Access Program. Complete the forms below and send to:

Sail Access CT Access Program
c/o Debbie Ballou
1 Riverside Court
Guilford, CT 06437

Make a copy and complete (handwrite) the information below. With your check mail your information to Debbie Ballou.

Name	______________________________
Date	______________________________
Address	______________________________
Apt. No.	______________________________
City, State	______________________________
Zip	______________________________
Home Telephone	______________________________
E-mail	______________________________
Work Phone	______________________________
Disability	______________________________
Able-bodied	______________________________

I would like to assist with

Publicity

Volunteer Skippers/Mates/instructor

Fundraising

Boat maintenance

Sail Training

Please have someone call me to discuss Sail Connecticut further

Where did you hear about Sail Connecticut?
____________________________________________

Would you be interested in taking sailing lessons? yes/no
Racing? yes/no

2) Personal Information Sheet

Name ____________________ Age ___________

If disabled, the nature of your disability(s)

Do you have any special needs we should know about?

Do you take any medication we should be aware of?

If necessary, is there a physician we should contact?

Name

______________________________

Address

______________________________

Town

______________________________

Phone Number.

______________________________

Who should we contact in case of emergency?

Name	______________________________
Relationship	______________________________
Phone Number	______________________________

3) RELEASE OF LIABILITY, INDEMNITY, AND HOLD HARMLESS AGREEMENT

SAIL CONNECTICUT ACCESS PROGRAM, INC.

I understand that sailing involves certain unavoidable risks, up to and including serious injury or death. The safety and comfort of all participants is the first concern of Sail Connecticut Access Program, Inc. (hereinafter called SCA), its volunteers, employees, agents, officers, directors, and representatives. I am aware that occasionally participants get wet or cold or both on sailing outings.

SCA has accommodations available for my safety and comfort including hoists for boarding, seatbelts, and cockpit seats to provide support, but I must keep each skipper informed about my needs and limitations before I sail and whenever problems arise during sailing. I will inform the skipper if I am unusually susceptible to cold or heat or seasickness, or if the heeling of the boat makes me uncomfortable.

I, for myself and my heirs, release and forever discharge from any and all claims, demands, and causes of action which are in any way connected with my participation, now or in the future, in any activity of SCA whether such claims, demands, and causes of action arise from bodily or personal injury, death, or property damage (whether or not caused by the negligence of SCA).

I agree to indemnify and hold harmless SCA, its volunteers, employees, agents, officers, directors, and representatives from any loss, liability, damage or cost, including reasonable attorney's fees, they may incur due to my participation in the activities of SCA, whether or not such loss, liability, damage or cost results from the negligence or other action of SCA, and its volunteers, etc.

I have read this agreement. I understand that this agreement contains a release of all claims, demands, and causes of action and an indemnity and hold harmless agreement and that no representation or statement on the part of any volunteer, employee, agent, officer, director, or representative of SCA will modify or terminate the provisions of this agreement.

I confirm that I have read this Release, I understand its contents, and I am signing it voluntarily.

_______________________________	____________
Signature	Date

_______________________________

Printed Name of participant

FOR PARENTS AND GUARDIANS OF PARTICIPANTS WHO ARE MINORS OR FOR PARTICIPANTS UNDER GUARDIANSHIP

I, the parent or legal guardian of the participant named above, do consent to and agree with the above agreement and do for myself and my heirs release and agree to indemnify SCA, its volunteers, employees, agents, officers, directors, and representatives, from any and all liabilities incident to the participation of the participant named above in the activities of SCA.

_______________________________	____________
Signature of Parent or Legal Guardian	Date

4) PHOTO/MULTI-MEDIA RELEASE

I/We _____________________________________hereby consent that the photographs, videotapes and/or motion picture media for which I/We pose, and/or audio recordings of my/our voice, while participating in Sail Connecticut Access Program activities may be used by the Sail Connecticut Access Program, Inc., (hereafter called SCA), its assign or successors, in whatever way they desire, including television and website; furthermore, I/We hereby consent that such photographs, films, recordings and the plates, digital media and/or tapes from which they are made shall be the property of SCA and SCA has the right to sell, duplicate, reproduce and make other use of such photographs, films recordings, plates, digital media and tapes as they may desire free and clear of any claim whatsoever on my part.

_________________________________________________

Name of Participant or Organization:

_________________________________________________

If minor Child, Name of Parent(s) or Guardian(s)

_________________________________________________

Address

_______________________________	____________
_______________________________	____________
Authorizing Signature(s) of participant, Organization, Parent(s) or Guardian(s)	Date

Our web site is hosted complements of: