| Email Address:* | | This email address will be used for all correspondence regarding your entry. |
| Sail Number:* | | |
| Fleet Selection:* | | |
| Sailor Name:* | | Sailors Full Name |
| T Shirt Size:* | | Please select the size for your sailor. Measurements are half chest. Adult size T shirts are longer. T Shirts are included in the cost of the clinic |
| Gender:* | | |
| Date of Birth:* | | |
| Sailors Opti Age:* | | The age your sailor turns in 2024 |
| Nationality:* | | |
| Yacht Club:* | | |
| Medical Conditions :* | | Outline any medical conditions and detail any medication that your sailor will bring to the clinic |
| Dietary Requirements:* | | Outline any dietary requirements here |
| Contact Person 1 - Name:* | | Parent / Guardian |
| Contact Person 1 - E mail:* | | Please do not use your sailor's contact details |
| Contact Person 1 - Phone Number:* | | Please do not use your sailor's contact details |
| Contact Person 2 - Name:* | | |
| Contact Person 2 - E mail:* | | Please do not use your sailor's contact details |
| Contact Person 2 - Phone Number:* | | Please do not use your sailor's contact details |
| Financial member of NZIODA?:* | | |
| Parent Help - can you provide assistance?:* | | Volunteers will be required to help the clinic run smoothly. A volunteer form will be shared closer to the clinic to confirm availability. |
| If yes, parents Name: | | |
| Is there anything else we should be aware of?: | | |
| I agree :* | | that my sailor will be bound by the NZIODA policies and all other rules that govern this event. I understand that yachting has inherent risks and dangers that are beyond the control of the organizing authority. I understand that neither the organising authority and its officers, members and servants nor other persons assisting with the conduct of this training clinic accept any responsibility in respect of any injury or loss to person or property that may be sustained by reason of participation in this clinic or howsoever arising in connection with the South Island Clinic. |
| I agree :* | | to the use of my photograph(s) and other relevant information in any event publicity and in the ongoing promotion of New Zealand yachting. I agree to the Organising Authority and Yachting New Zealand holding the above information for the general administration and well-being of the sport, and for them to retain, use and disclose the information to affiliated organisations and any other persons or organisations that Yachting New Zealand believes will further the interests and objectives of Yachting New Zealand. I acknowledge my right to access to and correction of this information. The consent is given in accordance with the Privacy Act 1993. |
| I agree :* | | to clinic personnel administering medication / medical treatment to my sailor if necessary. (You will be notified of any emergency using your contact number above) |
An invoice will be sent to you for payment soon. |
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Purchase Items |
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| Entry fee ($420) |
# required: |
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| Remember my details for next time: [?] | |
