Forms

SAILING ACCIDENT/INCIDENT REPORT  

Injured Person’s Name: Date of Report:  

Age of Injured: Date of Accident:  

Parent/Guardian Name: Time of Accident:  

Phone: Location of Accident:  

In what activity was person participating when accident occurred (class, lunch time, free play, etc.)?  _____________________________________________________________________________________________ 

What piece of equipment or boat, if any, was involved in accident?  ______________________________________________________________________________________________ 

Was there supervision at time of accident? (Yes No) By whom: _____________________________________________  Names of Witnesses: _______________________________________________________________

What part of body was injured? ________________________________________ Describe the type of injury (e.g. bruise, laceration, fracture, etc.)?  ____________________________________________

 Was first aid administered? (Yes No) By whom: _______________________________________________________  Was injured party referred to medical assistance? (Yes No) By whom: __________________________  Was an ambulance called? (Yes No) By whom: _________________________________________________________ 

​Exactly how did accident occur? Describe what happened:  

______________________________________________________________________________________________  ______________________________________________________________________________________________  ______________________________________________________________________________________________  ______________________________________________________________________________________________ 

Date person returned to program: ______________________  Restrictions on activities: _________________________________________________________ 

Name of Person Filing Report: ____________________________________________________  

Signature: ________________________________________ Date: ___________________  

Draw diagram on back of this sheet, if a collision was involved. List weather conditions, water conditions, water  temperature, air temperature, tide conditions, boat and equipment particulars.

VISUAL/AUDIO IMAGE RELEASE FORM 

I grant permission to Englewood Sailing Association Inc., (ESA) its employees and  agents, to take and use visual/audio images of me. Visual/audio images are any  type of recording, including photographs, digital images, drawings, renderings,  voices, sounds, video recordings, audio clips or accompanying written  descriptions. I agree that ESA owns the images and all rights related to them. The  images may be used in any manner of media without notifying me, such as web  sites, publications, promotions, broadcasts, advertisements, posters and theater  slides, as well as any other uses by ESA. I waive any right to inspect or approve  the finished images or any printed or electronic matter that may be used with  them.  

I release ESA and its employees and agents, including any firm authorized to  publish and/or distribute a finished product containing the images, from any  claims, damages or liability which I may ever have in connection with the taking  of use of the images or printed material used with the images.  

Student Name: ______________________________________________  Telephone: _________________________________________________  Email Address: _______________________________________________  Mailing Address: _____________________________________________  

I am at least 18 years of age and competent to sign this release. I have read this  release before signing. I understand its content, and I freely accept the terms.  Student Signature (if 18 years or older): ____________________  

Parent/Guardian Name (if student under 18 years):________________________ Parent/Guardian Signature (if student under 18 years):_____________________  Date: ______________ 

Sailing Program Waiver  

We, the undersigned being an applicant for admission to Englewood Sailing Association Inc., or a parent/  guardian of the applicant, do hereby acknowledge that participation in the sailing school and/or racing  program poses certain inherent risks which cannot be avoided and acknowledge that we are accepting those  risks.  

In consideration of the acceptance of applicant’s application, we release and forever discharge the  Englewood Sailing Association Inc., its Officers, its Board of Directors, its staff, and Sarasota County from any  claim for property damage, injury or death arising out of, or during the course of any participation in the  sailing school and/or racing program.  

We represent that we have and will maintain sufficient coverage under our homeowner’s or tenant’s liability  insurance policy for any negligent acts of applicant in his/her pursuance of school activities.  

We further certify that, to the best of our knowledge, the applicant is in good physical condition and suffers  from no physical, emotional or mental impairment which would adversely affect his/her ability to safely  participate in sailing activities.  

Student Name: ________________________________________________   

Date_________ Parent/Guardian (if applicant is a minor) _______________________________

Signature (parent/guardian if applicant is a minor)   ____________________________ 

PROGRAM RULES & DISCIPLINE POLICY  

1. No students on beach or water without supervision and a life jacket  

2. Life jackets must be worn at all times on docks, beach, boats, or in the water (by students, instructors, and  coaches)  

3. Closed toe and heel footwear to be worn at all times  

4. No running  

5. No swimming (except with the permission of the instructors)  

6. No jumping off boats (except with the permission of the instructors)  

7. Respect one another – no hitting, pushing, or roughhousing  

8. Use respectful language – no swearing, foul, or rude language  

9. No littering on land or water  

10. Stay with the class unless you have permission from an instructor to leave  

11. No destruction of club or private property  

12. No smoking, drugs or alcohol  

13. No playing on boat racks  

14. Watch fingers and feet between boats, docks, and moving parts  

15. Club owned boats must be properly returned and put away after use  

16. Sailors must make every effort to avoid collisions  

Discipline Policy:  Depending on the severity of the violation, the three strike policy will be followed.

1. First Strike: Student will be warned and student’s file will be noted.  

2. Second Strike: Student will be warned and parent/guardian will be informed and asked to meet with the Program  Director. The strike and meeting notes will be noted in student’s file.  

3. Third Strike: ESA’s board of directors will consider what action to take. This may include expulsion from the  program. ESA will not reimburse fees for expelled students. 

Name of Parent/Guardian ___________________________________   Signature of Parent/Guardian /Date  ____________________________________/ ______________

 ____________________________________  Student name 

JUNIOR SAILING PROGRAM MEDICAL FORM & RELEASE 

Student Name _________________________________________________________________  Date of Birth _________________ Sex _____ Height ____________ Weight ___________  

Please list any past and present medical problems ______________________________________________  Surgical history ________________________________________________________________  

Allergies: Medications ______________________________________________________  Foods ___________________________________________________________  

Other (including Bees, Wasps, Jelly Fish) _______________________________  

Current Medication Taken ________________________________________________________  

Date of Last Tetanus shot ________________________________________________________  

Physician’s Name _____________________________ Physician’s Telephone ___________  

Emergency Contacts (at least one should be local):  

1. __________________________________________________________________________  

Parent/Guardian Relationship Phone  

2. __________________________________________________________________________  

Parent/Guardian Relationship Phone  

3. __________________________________________________________________________  

Other Contact Relationship Phone  

4. __________________________________________________________________________ Other Contact Relationship Phone  ___________________

I, _____________________________________ , (Parent/Guardian) authorize the program organizers or their employees to  sanction emergency treatment if none of the student’s emergency contacts or Parent/Guardians can be reached at the time of  an emergency.  

______________________________________ _____________________  Parent/Guardian Signature