Liability Waiver

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I, the undersigned parent/guardian/legal custodian of ________________, a Participant in recreational activities and programs sponsored by the Port Jefferson Yacht Club Inc. agree that in consideration of Port Jefferson Yacht Club Inc. allowing the Participant to participate in its activities, the undersigned releases and discharges Port Jefferson Yacht Club Inc. officers, servants, employees and other persons including but not limited to providers of private and public transportation, including persons using their own vehicles and their heirs, administrators, executors, successors and assigns from, and hold them harmless against any claims, actions, causes of actions, suits, damages, and liabilities of any nature whatsoever, arising out of the Participants, participating in Port Jefferson Yacht Club Inc. activities and programs, including but not limited to, transportation of the Participant to and from other facilities by persons using their vehicles.

NOTE: Students taking an all-day session will be supervised during lunch period. However, morning or afternoon session students will not be supervised from 12:00 noon to 1:00 PM. Absolutely NO students are to be left at the Port Jefferson Yacht Club except during their sessions without prior arrangement between the Director and/or our Instructors. All students are to be picked up at the end of their sessions unless prior arrangements have been made.

Cancellation Policy

Should a summer program participant suffer an illness or injury prior to their program start date which prevents them from participating in regular activities (a note from a doctor will be required) the balance paid will be refunded less a $50.00 processing fee. Should a summer program participant decide not to attend a program for other reasons, not related to illness or i njury, the balance paid is non-refundable, UNLESS a fully-paid replacement for the spot is confirmed before the summer program begins. A $50.00 processing fee would apply. Under no circumstances will a refund be issued once a program has begun.

Damage Responsibility

I, the undersigned, assume the obligation for the expenses of repair and/or replacement of the program equipment, the damage of which is attributable to my child’s reckless or irresponsible behavior.

Parent or Legal Guardian Signiture  ________________________      Date ___________

Please mail the following forms along with your check made payable to address below:

  1. Sailing Instruction Application
  2. Student Emergency Contact & Medical Form
  3. Code of Conduct Form

Port Jefferson Yacht Club Inc.
ATTN: Joe Yorizzo, Director PJYC Sailing Programs
Surf Ave Pass Way
Port Jefferson, NY 11777

If you are paying by check – Please Include Payment in Full When You Register. Questions?

Please print this page, sign and return with student