Rochester Yacht Club
Adult Sail Private Lesson
Fill in each section and click submit at the bottom-right of the last section.
Private lessons are held on Ideal 18's or Sonars. * Please note, private lessons may only be held on RYC-owned boats. Participants must be at least 18 years of age.
City, State & Zip Code:
Previous Sailing Experience:
What are you looking to gain from this lesson?
How did you hear about us?
Consent, Waiver and Indemnity Agreement
THIS AGREEMENT MUST BE READ AND SIGNED BEFORE ANY STUDENT PARTICIPATES IN ANY ROCHESTER YACHT CLUB (RYC) CLASS. BY INITIALING THIS AGREEMENT, PARTICIPANT AFFIRMS HAVING READ IT. I understand that there are risks inherent in water-based and land-based programs and that accidents can occur in the water as well as on land during any RYC program. Such accidents can result in serious injury or death. I do for myself and our personal representatives, family, heirs and assigns, knowingly and freely waive all claims against and release and discharge RYC and its officers, directors, agents, employees and volunteers from any and all liability, loss, damage and expenses which may result from participation in RYC programs. RYC reserves the right to photograph program participants for publicity purposes.
I agree to the terms and conditions above. Please initial:
In Case of Emergency Contacts
Please provide all information necessary to provide as much safety and full participation as possible, please explain any YES answers below.
Date of Last Tetanus Shot:
Physician who conducted most recent physical examination:
Physician's Phone #:
Health Insurance Carrier:
Age as of 06/01/13:
High Blood Pressure:
Prescriptions taken on a regular basis:
Special Accomodations (glasses, contacts, etc.):
Special Learning/Behavioral Needs:
Please list available dates for lessons, we will do our best to accomodate you. You will be contacted with finalized dates after you submit this form.
Duration of Lesson:
New Member Voucher
Must provide voucher with payment.
Pay online by credit card or PayPal account
Pay online by member number