Forms

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Sail Connecticut Access Program

2012 Membership Form

 

YES… I would like to join and/or support the Sail Connecticut Access Program !!

I enclose my membership dues of $45*: $ _______

 I would also like to make a donation to Sail CT Access:                              $ _______

 I enclosed is my check payable to “Sail CT Access” for (total):           $ _______

 

Name _________________________ email ____________________________

Address __________________________   Town or City ___________________

State __________  Zip Code _____________  Telephone # ________________

Disability or special need, if applicable _________________________________

*Your membership entitles you and one accompanying person to sail with us as often as you like, as long as boats and skippers are available.

(Please note that Sail Ct Access is a 501(c)(3) non-profit organization; your donation may be tax deductible to the extent permitted by law)

Please mail this form, your check, and your Liability Release  form to:

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

 

Thank you for being as generous as you can with your donation in support of Sail CT Access!

 

 

  

COMPLETE, SIGN, AND SEND IN THIS RELEASE WITH YOUR MEMBERSHIP APPLICATION .

PLEASE READ THE RELEASE CAREFULLY!

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 also 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, PFD’s, 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.

TO BE SIGNED AND DATED BY ALL PARTICIPANTS AND THE PARENTS OR GUARDIANS OF

PARTICIPANTS WHO ARE MINORS OR UNDER GUARDIANSHIP

_____________________________       __________________

Signature of Participant                                    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.

 

_______________                         ________________________________                ________________________________

Date                                                        Printed Name of Parent or Legal Guardian                Signature of Parent or Legal Guardian

 

IN CASE OF ANY EMERGENCY, WHOM SHOULD WE CONTACT?

________________________________________        _________________     ________________

Name & Relationship                                                                                     Telephone Number(s)