Contact and Medical Info

Sailor's First Name *

First

Sailor's Last Name *

Last

Guardian First Name *

First

Guardian Last Name *

Last

Email *

Cell Phone *

Please list a CELL PHONE so that we may text you in the event of weather emergencies, venue changes, etc. If we cannot text you, or it's a land line, please note this after your phone number.

Sailor's Age *

Pediatrician's Name and Phone Number *

Allergies, special needs

Do NOT use pictures or video of my child to advertise for CSC

I do NOT consent for my child to appear in CSC promotional materials

For our program to be successful, we really need to publicize how much fun our sailors are having learning to sail. If this box is unchecked, your child might appear in photos/videos on our website or Facebook page.

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