Sailing Program Application "*" indicates required fields YMCA Membership VerficationI/We are YMCA member:*YMCA General Membership is a one-time lifetime payment of $50.00. It is not willable; non-refundable. Minors who are ward of the State in foster care/guardianship shall establish individual YMCA membership. This will allow the YMCA membership to follow the minor should they transfer foster care/parents. Register online or call 808-935-3721 to check on YMCA General Membership. Yes No You must have a current YMCA Lifetime membership for your household in order to enroll in YMCA programs. YMCA Membership is $50 for lifetime and covers all family members in your household. To become a YMCA member, enroll online, click here After you have your YMCA membership, please continue to complete the application below. YMCA membership does not guarantee acceptance into YMCA camp and summer programs.Sailing Program Session*Please select the sessions you are able to attend. We will place you in a session according to availability. Any available Beginners Sailing Session Any available Intermediate/Advanced Sailing Session Water ExperienceDoes the applicant have any kind of watercraft experience (inclusive but not limited to prior sailing, powerboat, canoe, kayak, SUP). Please describe below.Where are they experienced?*(ocean, lake, river etc) Age at the time of experience* What was the experience* Does the applicant swim in the ocean regularly, or surf?*Please describe Can the applicant swim 50 yards unassisted?*This is a requirement for safe participation and will be tested. Yes No Height*Height in feet and inches Weight*Weight in lbs.Does the applicant have any health issues that staff should be aware of?* Yes No Health issuesWhat are the applicant's primary goals for taking the sailing class?*Please check all that apply Water safety Boat handling Basic sailing skills Sailing proficiency (single handing, moderate to windier conditions, waves) Intermediate sailing (racing fundamentals) Advanced sailing (racing skills) Other Other goals Applicant InformationThis form will require file uploads of the following items. Please take a moment to gather and image the required documents. School IEP Plan (if you have one) Medical Insurance card Birth certificate or proof of attendance at any public or private school Participant Name* First M.I. Last AgeDate of Birth* MM slash DD slash YYYY Current Grade* School* IEP/504*Individual Education Plan, please include copy if Yes Yes No Unsure IEP File Upload*Accepted file types: jpg, jpeg, png, pdf, Max. file size: 6 MB.Physical Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Camper Lives with:* Mother Father Grandparents Legal Guardian(s) Foster Other Situation Camper Living situationIf living with "other" please describe camper living arrangements Parental ContactsMother Name* First M.I. Last Mother Email* Mother Cell Phone*Mother Work PhoneMother Employer* Father Name* First M.I. Last Father Email* Father Cell Phone*Father Work PhoneFather Employer* Does the camper have a cell phone?* Yes No MedicalMedical Insurance* Policy Number* Policy Holder* Medical Insurance Card*Accepted file types: jpg, jpeg, png, pdf, Max. file size: 6 MB.Camper's Doctor* Doctor's Phone*Preferred Health Care Center* Has camper received COVID vaccinations?* Yes No Allergies* Yes No Allergies InfoMedication* Yes No Medication ListPlease list medicationsDoes the camper have any physical limitations?* Yes No If there are physical limitations please explain:Does the camper have any behavior concerns?* Yes No If there are behavior concerns please explain:Is there anything else that we need to know to best care for your child?* Yes No Additional care information:Emergency Contacts*Please list at least 2 contacts. (IN ADDITION TO THE PARENTS/ LEGAL GUARDIANS, I AUTHORIZE ONLY THE FOLLOWING PEOPLE TO PICK UP MY CHILD AND/ OR IN AN EMERGENCY, BE CONTACTED IF THE PARENT/ LEGAL GUARDIAN CAN'T BE CONTACTED.)Full NameRelationshipCell PhoneWork Phone Add RemoveReleases & WaiversMEDICAL RELEASE/WAIVER:*In the event of a medical emergency if neither the parent/ legal guardian nor emergency contact persons cannot be promptly reached, I hereby authorize the YMCA staff to take my child to the nearest medical facility for care. INSURANCE DISCLAIMER: IT IS THE MEMBER AND/OR PARTICIPANTS RESPONSIBILITY TO PROVIDE HIS/ HER OWN ACCIDENT AND HEALTH INSURANCE. THE ISLAND OF HAWAII YMCA DOES NOT CARRY HEALTH AND ACCIDENT INSURANCE FOR MEMBERS OR PARTICIPANTS. I agreePHOTO/ VIDEO RELEASE/ WAIVER:*The Island of Hawaii YMCA has my permission to use my child’s photograph, video, artwork, profile and/or story and any likeness in any of its publication’s web pages, and other promotional materials produced, used by, and representing the YMCA. I understand that the circulation of the materials could be worldwide and that there will be no compensation to me or my child for this use. This includes photographs, videos, and artwork during program hours as well as special events, camps, and other YMCA related outings outside of regular hours. I agreeEXCURSION RELEASE WAIVER:*I hereby give permission for my camper to leave the Island of Hawaii YMCA without a parent/ guardian on all day camp field trips. All campers will be under direct care of camp staff during field trips. By signing below, I give the YMCA permission to travel to the locations of these excursions and allow for my camper to participate at these excursions. I agreeREFUND POLICY:*REFUND POLICY: NO REFUND ON YMCA GENERAL MEMBERSHIP Refund may be available 3 workdays before the start of camp. Once camp has begun, NO REFUNDS. A $50.00 processing fee will be assessed, and the remainder may be refunded. The request for a refund must be completed in writing indicating amount paid, child’s name, parent’s name, and reason for cancellation. Refunds will not be honored for enrollment in another program. I agreeYMCA COMMITMENT: The YMCA will reserve your child’s spot in camp and guarantee childcare once payment and Y membership is established. Household Income Size (Optional)FOR STATISTICAL & GRANT APPLICATION PURPOSES ONLY. (NOTE: YOUR HOUSEHOLD INCOME BRACKET DOES NOT DETERMINE AWARDS FOR FINANCIAL ASSISTANCE.) $0 - $24,000 $25,000 - $36,000 $37,000 - $50,000 $51,000 - $74,000 $75,000+ PLEASE ATTACH ONE OF THE FOLLOWING TO YOUR APPLICATION: Child's birth certificate Proof of attendance at any public or private school Letter of acceptance to any public or private school Birth Certificate or Proof of School Enrollment file upload*Accepted file types: jpg, jpeg, png, pdf, Max. file size: 6 MB.Parent/Guardian Name* Child's Name* Submitter's Email* Signature Reset signature Signature locked. Reset to sign again Signed Date* MM slash DD slash YYYY
