For a copy of the course descriptions, registration and waiver forms, click here .

Lake Beulah Sailing School

2010 Registration Form

(One form per family)

Family Name:_________________________________________________________________________

Full Address:       ______________________________________________________________________

Summer Daytime Phone: ________________________________________________________________

Email Address: ________________________________________________________________________

Emergency Phone while student attends Sailing School: ________________________________________

* Students in Green Fleet classes, who do not own an Optimist, may charter an LBSS Optimist boat (to be stored at the yacht club) for a $50 fee. Please note that a signed charter agreement must be on file with LBSS (to be available at the Orientation Meeting).

** Red/White/Blue Fleet students who do not own an Optimist may rent a charter boat (to be stored at home) for $200/hull, $150/sail and $150 damage deposit. Contact Jim Kutschenreuter to make arrangements.

*** Students enrolled in more than one program will be charged only for the higher price for lessons in both sailboats.

In addition, please read carefully and submit a completed WAIVER AND RELEASE OF ALL CLAIMS and Medical Form. Be aware that by signing up on the registration form and on this agreement you will be waiving and releasing all claims for injuries you or your child/ward might sustain arising out of the activities of this program. Your signature is required on the application stating that you agree with this policy.

Please make check payable to Lake Beulah Sailing School and either mail/submit this form on or before May 30, to:

LBSS Registration, PO Box 729, East Troy, WI 53120

LAKE BEULAH SAILING SCHOOL, INC.

LIABILITY WAIVER

The Lake Beulah Sailing School, Inc. (LBSS) is committed to conducting its programs and activities in the safest manner possible and holds the safety of the participants in the highest possible regard. Participants and parents registering their child in LBSS programs must recognize, however, that there is an inherent risk of injury when choosing to participate in recreation activities. The Lake Beulah Sailing School, Inc. continually strives to reduce such risks and insists that all participants follow safety rules and instructions that have been designed to protect the participants’ safety. Please recognize that the LBSS does not carry medical accident insurance for injuries sustained in its programs. The cost of such would make program fees prohibitive. Therefore, each person registering themselves or family members for a program activity should review their own health insurance policy for coverage. It must be noted that the absence of health insurance coverage does not make The Lake Beulah Sailing School, Inc. automatically responsible for payment of medical expenses. Due to the difficulty and high cost of obtaining liability insurance, execution of the following Waiver and Release is required. Your cooperation is greatly appreciated. Please read this form carefully and be aware that in participating in the program(s) listed in the Registration Form, you will be waiving and releasing all claims for injuries you might sustain arising out of the activities of the program.

WAIVER AND RELEASE OF ALL CLAIMS

“As a participant (or as a parent/guardian of participant under age 18) I, the undersigned, recognize and acknowledge that there are certain inherent hazards and dangers and that serious accidents occasionally occur during sailing and tennis activities and that participants in these activities occasionally sustain serious personal injuries, and/or property damage, as a consequence thereof. Knowing the risks of this, the undersigned do hereby agree to assume those risks and to release and discharge all of the persons or entities mentioned below.”

“The undersigned, in consideration of the participant named below, being permitted to participate in sailing and tennis events, programs, and training and practice for such events, and in consideration of the use and enjoyment of the facilities, assistance and instruction, do hereby release and discharge the servants, agents, and employees, the owners and lessees of the premises on which any sailing and tennis events, programs, training and practice take place, and the officers, agents and employees of any such individuals or entities, from any and all liability or claims for damages for personal injury, death, property damage or any other loss which the participant named below or the undersigned may sustain as a result of such participation in sailing or tennis events, programs, practice and training, whether or not that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above.”

“The undersigned do further release all officials, professional personnel and any other person from any claim whatsoever on account of first aid, treatment or services rendered to the participant mentioned below in such activities.”

“Further, the participant named below has medical insurance under which participant is covered for any injury or other loss which may result from participating in sail sailing or tennis events, programs, training or practice. In the event of emergency, I authorize Lake Beulah Sailing School, Inc. officials to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for the participant named below, for immediate care and agree that I will be responsible for payment of any and all medical services required.”

“This release contains the entire agreement between the parties hereto, which the undersigned have carefully read, understand, and sign of their own free will, knowing the terms of this release are contractual and not a mere recital.”

Participant(s)______________________________________________________________

                                 (Print participant’s (s’) name)

Parent signature____________________________________Date_____________________

Parent signature____________________________________Date_____________________

1. Medical Form

Student Name: _____________________________  Date: _______________________

Emergency Contact Information:

Parents’ Name: ____________________________________________________

Parents’ Address:___________________________________________________

Daytime Phone: ___________________ Email address:_____________________

Mother’s Employer Contact and Phone: _________________________________

Father’s Employer Contact and Phone: __________________________________

Alternate Emergency Contact and Phone: ________________________________

Who do you wish we contact first in case of emergency: ____________________

Where are the student’s medical records kept: ____________________________

List any factors that are pertinent to emergency medical treatment:

· Blood Type (if known)_____________________

· Allergies ________________________________

· Date of last tetanus shot ____________________

· Current medications _______________________

· Medical conditions (Circle and explain): Diabetes, Asthma, Epilepsy, Bleeding, Heart condition, other: __________________________________________________________________

· Does the student have a history of, or currently have, any physical limitations or chronic ailments which may prevent full participation in this course? __________________________________________________________________

· Student’s Doctor and Phone Number___________________________________

· Insurance carrier___________________________________________________

· Preferred hospital ______________________________________________ 

Parent/Guardian Medical Treatment Authorization: 

In the event of emergency, I authorize Lake Beulah Sailing School, Inc. officials or their employees to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for the participant named above, for immediate care and agree that I will be responsible for payment of any and all medical services required. 

Parent signature________________________________Date_____________________