Step two
MBBC JUNIOR SAILING PROGRAM
ONLINE REGISTRATION FORM
For Non Members
Ages 8-18

Please register one sailor at a time:

Sailor's Last Name
Sailor's First Name
Date Of Birth mm/dd/yy
Sailing Experience
Mother's Last Name
Mother's First Name
Father's Last Name
Father's First Name
 Sailor's Address
City
State   ZipCode 
Mother's Home Phone
Mother's Work Phone
Father's Home Phone
Father's Work Phone
Parental Email Address

Select Session(s)  Schedule 2024
$ Private Lesson 1 hour All Season 5 PM - 6 PM weekdays 60
$ Sailing Instruction i
has 7 openings
June 17 - June 28 9 AM - noon 270
$ Sailing Instruction ii
has 8 openings
July 1 - July 12 9 AM - noon 270
$ Advanced Race Instruction 1
has 14 openings
June 17 - July 12 1 PM - 4:30 PM 365
$ Sailing Instruction iii
has 8 openings
July 15 - July 26 9 AM - noon 270
$ Sailing Instruction iv
has 8 openings
July 29 - August 9 9 AM - noon 270
$ Advanced Race Instruction 2
has 14 openings
July 15 - August 9 1 PM - 4:30 PM 365
$ Private Lesson 2 hours All Season 5 PM - 7 PM weekdays 90
$ Private Lesson 3 hours All Season 5 PM - 7 PM weekdays -or- by appointment 120
Your Total  
Special Instructions or
Concerns other than medical.
Primary Emergency Contact Which parent do we call first!
In case you are unavailable
Who do we contact.
Their Relationship
Their Work Phone
Their Home Phone
Physician
Physician Phone
Health Insurance Company
Policy Number
Height and Weight format: 5 ft. 3 in. 110 lbs.
Last Tetanus Booster mm/dd/yy
Contact Lenses
Allergies
Medications
Medical concerns which affect your child’s ability to participate in the class or that
 would be pertinent to emergency medical treatment :


If paying by check:
Payable to: Malletts Bay Boat Club

Mail check to

Malletts Bay Boat Club
Junior Sailing
PO Box 402
Colchester, VT 05446

Want more information or have questions? Please contact:

Rich Miller

jrsailing@mbbc-vt.org