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Olympia Yacht Club Sailing Education Program
Medical Emergency Release & Liability Agreement Waiver

Liability Agreement Waiver

I understand that sailing, and all activities involved around and during sailing programs of any nature are inherently dangerous, and may lead to injury, harm or death. In consideration of my child participating in the Olympia Yacht Club Sailing Education Programs as a guest, participant or student, I agree to accept all risk of injury to my child, to hold the Olympia Yacht Club, its officers, directors, employees, and members harmless, released, and indemnified from any claims, of any nature whatsoever arising out of the activities of the Adult, Youth or High School Sailing Program. Should my child be in need of medical treatment, my signature below confirms my permission for this to be done in the event that I cannot be reached promptly. By signing this document I confirm that I have read, understood and agree to all the terms and conditions stated in the waiver.

Other Provisions

  • My child is a capable swimmer and will wear a lifejacket while on the water.
  • I authorize the program organizers or their employees to sanction emergency treatment.
  • I permit Olympia Yacht Club Sailing Education Program to use photos and quotes of any participants in their publications.

​

Date: April 28, 2024

©Olympia Yacht Club - Reviewed/Updated February 2021

First Sailor's Name

First Name*

Last Name*

Phone*
First Sailor's Date of Birth*
First Sailor's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
First Sailor's Signature*
Second Sailor's Name

First Name*

Last Name*
Second Sailor's Date of Birth*
Second Sailor's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
Third Sailor's Name

First Name*

Last Name*
Third Sailor's Date of Birth*
Third Sailor's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
Fourth Sailor's Name

First Name*

Last Name*
Fourth Sailor's Date of Birth*
Fourth Sailor's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
Fifth Sailor's Name

First Name*

Last Name*
Fifth Sailor's Date of Birth*
Fifth Sailor's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
Sixth Sailor's Name

First Name*

Last Name*
Sixth Sailor's Date of Birth*
Sixth Sailor's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
Seventh Sailor's Name

First Name*

Last Name*
Seventh Sailor's Date of Birth*
Seventh Sailor's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
Eighth Sailor's Name

First Name*

Last Name*
Eighth Sailor's Date of Birth*
Eighth Sailor's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
Ninth Sailor's Name

First Name*

Last Name*
Ninth Sailor's Date of Birth*
Ninth Sailor's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
Tenth Sailor's Name

First Name*

Last Name*
Tenth Sailor's Date of Birth*
Tenth Sailor's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
Sailor's 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 or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.

Mother's Name:

Phone 1:

Phone 2:

Father's Name:

Phone 1:

Phone 2:
Secondary Emergency Contact Information:

Contact:

Relation:

Phone:
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 or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Medical Emergency Release Information: please read, and fill out thoroughly 


Please list any known conditions which may preclude the above named child from participating in sailing:

Please list any known conditions which may require consideration in the event of an emergency:

Please list all known allergies:

Select One:

Do you have Asthma?*
If yes, do you carry an inhaler?
Do you carry an epi-pen?*
Do you have Diabetes?*

Personal Physician:

Phone:

Insurance Carrier:

Policy #:

Group#:
Parent or 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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