Sailing Program Application

"*" indicates required fields

YMCA Membership Verfication

I/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

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.

Session 1 Beginner's Sailing June 12-15

Session 2 Beginner's Sailing June 19-22

Session 3 Beginner's Sailing June 26-29

Session 4 Beginner's Sailing July 3, 5-7

Session 1 Intermediate Sailing Session July 10-13

Session 2 Intermediate Sailing Session July 17-20

Water Experience

Does 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

Height*

Height in feet and inches

Weight*

Weight in lbs.

Does the applicant have any health issues that staff should be aware of?*

Yes

Health issues

Tshirt Size*

What 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 Information

This 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

Age

Date of Birth*

Current Grade*

School*

IEP/504*

Individual Education Plan, please include copy if Yes

Yes

Unsure

IEP File Upload*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 6 MB.

Ethnicity*

For statistical and grant application purposes. Please select up to three (3) choices.

Part Hawaiian

Hawaiian

Asian

White

Part African-American

African-American

Pacific Islander (Micronesian, Polynesia, Samoa, Tahiti, Tonga)

Physical Address*

Street Address Address Line 2 City State ZIP Code

Camper Lives with:*

Mother

Father

Grandparents

Legal Guardian(s)

Foster

Other Situation

Camper Living situation

If living with "other" please describe camper living arrangements

Parental Contacts

Mother Name*

First M.I. Last

Mother Email*

Mother Cell Phone*

Mother Work Phone

Mother Employer*

Father Name*

First M.I. Last

Father Email*

Father Cell Phone*

Father Work Phone

Father Employer*

Does the camper have a cell phone?*

Yes

Medical

Medical 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

Allergies*

Yes

Allergies Info

Medication*

Yes

Medication List

Please list medications

Does the camper have any physical limitations?*

Yes

If there are physical limitations please explain:

Does the camper have any behavior concerns?*

Yes

If there are behavior concerns please explain:

Is there anything else that we need to know to best care for your child?*

Yes

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 Name

Relationship

Cell Phone

Work Phone

Releases & Waivers

YMCA 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

Signed Date*

Sailing Program Application

YMCA Membership Verfication

Water Experience

Applicant Information

Parental Contacts

Medical

Releases & Waivers

YMCA COMMITMENT:

Member Portal