Loading...

Top portion of this form is for the Sailor/Participant with a disability; list any able-bodied others in the bottom portion of form.

TODAY’S DATE: May 25, 2026

LOCATION of DOCKS: 60 Fort Adams Drive, Newport, RI. (No mail receptacle at this address!)

I/We have read and signed the “Waiver(s) of Liability.” Each person who boards a boat needs to have a current-year Waiver of Liability on file with Sail To Prevail. Please submit all Waiver(s) of Liability with this Registration Form.

I Agree

Payment may be mailed to: Sail To Prevail - PO Box 1264, Newport, RI 02840
For further details, contact the Head Sailing Instructor: sailingdirector@sailtoprevail.org - 401-849-8898 ext. 3


First Sailor's Name
First Name*
Last Name*
Select Gender
First Sailor's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
First Sailor's Signature*
Second Sailor's Name
First Name*
Last Name*
Select Gender
Sailor's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
Third Sailor's Name
First Name*
Last Name*
Select Gender
Sailor's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
Fourth Sailor's Name
First Name*
Last Name*
Select Gender
Sailor's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
Fifth Sailor's Name
First Name*
Last Name*
Select Gender
Sailor's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
Sixth Sailor's Name
First Name*
Last Name*
Select Gender
Sailor's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
Seventh Sailor's Name
First Name*
Last Name*
Select Gender
Sailor's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
Eighth Sailor's Name
First Name*
Last Name*
Select Gender
Sailor's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
Ninth Sailor's Name
First Name*
Last Name*
Select Gender
Sailor's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
Tenth Sailor's Name
First Name*
Last Name*
Select Gender
Sailor's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
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
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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*
Relationship*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Information
CLIENT TYPE: (No more than 5 people per boat, including individual(s) with disabilities.)*
1 boat, $70 (pay online or bring to dock.)
I am applying for a scholarship (Attach Financial Aid form.)
Contact Person (if different than Participant, otherwise write "self") *
Relationship *
Contact Person’s Email *
Contact Person’s Phone (Home or Cell) *
Sailor’s Primary Care Physician *
Physicians's Phone Number *
What is Sailor’s disability? *
MEDICATION: Will Sailor/participant need medication administered during a two-hour sail?*
No
Yes
MILITARY SERVICE: Is this participant a Military Veteran?*
No
Yes
If Yes, what Branch?
EXPERIENCE: Has Sailor participated in Sail To Prevail programs before?*
Yes
No, this is my first time at STP.
Sailing Skill Level:*
Beginner
Intermediate
“Seasoned Salt”

OTHERS: These individuals (without disabilities) will accompany the above disabled Sailor/participant on the boat: (FIRST and LAST NAME - AGE - M/F - RELATIONSHIP TO DISABLED SAILOR Mom, Dad, Brother, Sister, Friend, Caregiver, etc.)
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!