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2023 SHYC JR: Medical, Emergency Contact, Permission to Treat, Contact Info
Please complete this form to authorize emergency treatment for your child for the SHYC Junior Programs.
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詳細
* 必須の質問です
メールアドレス
*
メールアドレス
Participants/Child Name
*
回答を入力
Date of Birth
*
YYYY
/
MM
/
DD
Street Address
*
回答を入力
City
*
回答を入力
State
*
回答を入力
ZIP
*
回答を入力
Alternative Email
*
回答を入力
Gender
*
Female
Male
FOR SAILING PROGRAM PARTICIPANTS ONLY: Check the "YES" box below to authorize SHYC to provide your child's contact information (name, DOB, gender, parent email, parent cell, mailing address) to US SAILING to create a JR US SAILING Membership and Skill-UP account for your child to use as part of the Sailing Program at SHYC. Learn more at:
https://www.ussailing.org/membership/organizations/skill-up/
*
YES: I authorize the SHYC program organizers or their employees to provide this information to US Sailing for this purpose.
NO: I do NOT authorize this and do NOT want my child to be part of Skill-Up or US SAILING
My child is NOT in the SHYC Sailing program, so this is NOT applicable
その他:
必須
Height (inches)
*
回答を入力
Weight (lbs)
*
回答を入力
US SAILING: If you have a Family US SAILING Membership or your child is a Youth Member of US Sailing, indicate US Sailing Member # here. If you don't know, or are not a USS member, skip this question.
回答を入力
Please list any current or past medical problems:
*
回答を入力
Surgical History:
*
回答を入力
List all Allergies (Medication, Foods, Bees, Wasps, Jelly Fish, or more):
*
回答を入力
Current Medication Taken:
*
回答を入力
Date of last Tetanus shot:
*
回答を入力
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