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Veterans/First Responders

Making Sailing Accessible to All!​

This form MUST be completed and signed before participating in any Team Paradise Sailing, Inc., activity.

Participation Agreement

I, the undersigned, intending to be legally bound, do hereby for myself, my hiers, executors and administrators, waive and release any and all rights and claims for damage which I may have against Team Paradise Sailing, Inc., their representative, successors and employees for any injuries which I may sustain in connection with my participation in the Veterans Sailing Program for veterans with disabilities.

In consideration of Team Paradise Sailing, Inc. and/or US Sailing Center, Participant fully assumes all risks and waives all liability in connection with participation in any program, and in executors, or administrators and Participant's undersigned parent, guardian or aide (if applicable) remise, release, indemnify, acquit and hold harmless and forever discharge Team Paradise Sailing, Inc. and/or US Sailing Center, their directors, employees, and agents, instructors, including volunteers, rescue and support personnel, from any and all liabilities, obligations, damages, claims, causes of action, judgments, costs and charges which Participant may have or which may be incurred for any reason of any occurrence during travel to and from the event, or during participation therein, whether resulting from any acts or omissions of any persons, from the operation or condition of facilities or premises, or from acts of God or nature. Participant hereby agrees to comply with all rules and regulations, and gives permission for the free use of their name and picture in any media account of Team Paradise Sailing, Inc., and/or US Sailing Center program or any future public relations or fundraising activity including any picture, live television, video tape, digital, or audio recording captured while participating in Team Paradise Sailing, Inc., programs or events and while utiliizing Team Paradise Sailing, Inc. and/or US Sailing Center, facilities. Participant also agrees to assume liability for any and all damages to Team Paradise Sailing, Inc. and/or US Sailing Center property that is under Participant's control while participating in any Team Paradise Sailing, Inc. and/or US Sailing Center activity.  By visiting Team Paradise Sailing, Inc., and/or the US Sailing Center Miami, you voluntarily assume all risks of exposure to COVID-19.

Team Paradise Veterans Sailing Program

Rules & Guidelines

We are excited that you are interested in participating in the Team Paradise Veterans Sailing Program!  The ongoing success of this program heavily relies on your participation and involvement. As much as we would like to include everyone in the program, we do have some limitations, therefore, we have rules and policies that all must abide by in order to ensure that program is able to operate safely, effectively, and fairly. Please review the guidelines below:

Conduct: It is expected that everyone will be treated respectfully. Political, religious, and social issues can be matters that often stir up strong emotions and opinions, therefore, it is best to keep conversations related to these topics light and if a staff person requests that you end a conversation regarding a matter, that you do so respectfully. Any behavior or conduct that is deemed inappropriate, aggressive, or antagonist towards other participants, staff, or the public, may result in dismissal from the program with notification to your provider.

Confidentiality and Disclosure: This program serves veterans with various service-related disabilities and conditions.  Any information provided to us regarding your disability and/or condition is kept confidential and will not be shared with others. We do ask that you disclose any pertinent information regarding your disability so that we can be more prepared in accommodating you and handling any issues that may arise related to your disability. 

Safety: Please adhere to all safety rules and guidelines as well as any instructions given by staff. Failure to do will result in suspension or dismissal from the program per the Program Director's discretion.

I understand the following rules and guidelines set forth and agree to adhere to them. I understand that failure to abide by any of these guidelines may result in the denial of participation in the program or dismissal from the program.

 

May 9, 2024

 

 

Please select who will be participating...
AdultMinor
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First Participants Name

First Name*

Middle Name

Last Name*

Phone*
First Participants Date of Birth*
First Participants Information
Can you swim?*
No
Yes

Please explain your type of disability. (This information will be kept confidential.) *

Any special precautions that we should be aware of? *

Types of assistance required: *

How did you find out about the Team Paradise Veterans Sailing Program? *

Have you been or are you currently being treated for PTSD? (Yes or No) *

If you have been or are currently being treated for PTSD, is it combat related? (Yes or No) *

Do you have difficulty around loud sounds such as gunfire/fireworks? (Yes or No) *

Do you have difficulty around crowds? (Yes or No) *

What triggers your symptoms?

How do you cope with your symptoms?

Who is your treating Recreation Therapist and Physician? (Please provide their phone number.) *

What are your personal goals for participating in this program? *
First Participants Signature*
Participants Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent/Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.

Branch of Service: *
Emergency Contact Information

Last Name *

First Name *

Phone Number *

Relationship to Participant

Address *

City *

State *

Zip *

E-mail Address *

Preferred Hospital *
Veterans Ethnicity (please choose one) *
Caucasian/White
African American/Black
Latino/Hispanic/Spanish
European
Native American/Alaskan Native
Hawaiian/Pacific Islander
Asian
Other
Photo Release

I hereby give Team Paradise Sailing, Inc., permission to use for promotional purposes any picture, live television, video tape, digital, or audio recording of me captured while participating in Team Paradise Sailing, Inc., programs or events, and while utilizing Team Paradise Sailing, Inc., facilities.

I fully understand that my likeness may appear in booklets, brochures, print advertising, web sites, social media, and videos promoting Team Paradise Sailing, Inc., and its Veterans Sailing Program.

I fully understand that I will not be compensated for the use of my image.


Signature

Print Name: *

Address (Street/Apt.#/City/State/Zip): *

Today's Date: *

I am 18 years old or older and understand and fully agree to the terms and conditions of this release.

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent/Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent/Guardian's Date of Birth*
Parent/Guardian's Information
Can you swim?*
No
Yes

Please explain your type of disability. (This information will be kept confidential.) *

Any special precautions that we should be aware of? *

Types of assistance required: *

How did you find out about the Team Paradise Veterans Sailing Program? *

Have you been or are you currently being treated for PTSD? (Yes or No) *

If you have been or are currently being treated for PTSD, is it combat related? (Yes or No) *

Do you have difficulty around loud sounds such as gunfire/fireworks? (Yes or No) *

Do you have difficulty around crowds? (Yes or No) *

What triggers your symptoms?

How do you cope with your symptoms?

Who is your treating Recreation Therapist and Physician? (Please provide their phone number.) *

What are your personal goals for participating in this program? *
Parent/Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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