Select the Week(s) Your Sailor is Attending *

Week 1: June 12 - 16

Week 2: June 19 - 23

Week 3: June 26 - 30

Week 4: July 10 - 14

Sailor's Name *

First Name

Last Name

Sailor's Cell Phone *

(###)

###

####

Sailor's Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian #1 Name *

First Name

Last Name

Paren/Guardian Cell Phone *

(###)

###

####

Parent/Guardian #2 Name *

First Name

Last Name

Parent/Guardian #2 Cell Phone *

(###)

###

####

Emergency Contact *

Please enter the full name of your emergency contact. This must be someone other than the parent/guardian.

First Name

Last Name

Emergency Contact's Phone *

(###)

###

####

Primary Care Physician *

First Name

Last Name

Primary Care Physician's Phone Number *

(###)

###

####

Sailor's Birth Date *

(Must be between the ages of 9 and 14)

MM

DD

YYYY

Sailor's Gender *

Male

Female

Describe Your Sailor's Water Comfort Level *

Non-swimmer - not comfortable in water.

Able to float with a low level of water comfort.

Competent swimmer - comfortable in water.

Highly competent - very comfortable in water.

Prior Sailing Experience *

No - First-time sailor.

Yes - From classes with Team Paradise.

Yes - From classes with another program.

Yes - From sailing with family/friends.

What Type of School Does Sailor Attend? *

Public

Private/Charter

Home School

Sailor's Ethnicity *

Caucasian/White

African American/Black

Latino/Hispanic/Spanish

European

Asian

Native American/Alaskan Native

Pacific Islander

Other

Household Income *

Less than $25,000

$26,000 - $50,000

$51,000 - $75,000

$76,000 - $100,000

Over $100,000

Prefer not to say.

Household Info. *

Two-Parent Household

Single-Parent Household

Custodial Parent/Guardian

Does Sailor Receive Free or Reduced Meals at School? *

Yes

No

Prefer not to say.

Does Sailor Have a US Sailing Membership/ID Number? *

Yes

No