Select Camp Sessions*You are now able to Register for multiple sessions. Click on the Sessions you wish to register for and complete the registration process. If the session is full, you can place your child on a wait list for that session or choose another session. Session 1: June 26 – July 7 (4 spaces available) Session 2: July 10– July 21 (1 spaces available) Session 3: July 24 – August 4 (0 spaces available. Join the waitlist!) Session 4: August 7 – August 18 (0 spaces available. Join the waitlist!) Scholarship (8 spaces available) Child's InformationChild's Name* First Last Child's Gender* Female Male Child's Birthdate*(mm/dd/yyyy) MM slash DD slash YYYY Parent/Guardian InformationParent/Guardian Name (primary contact)* First Last Parent/Guardian Email* Enter Email Confirm Email Home Phone*Cell Phone*Home Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Additional Contact Information (1)Please provide the name and phone number of another parent, guardian, family member or neighbor who can be contacted if we are unable to reach you. Please state their relationship to the child.Contact Name* First Last Phone for Contact*Contact's Relationship to Child* Additional Contact Information (2)Please provide the name and phone number of another parent, guardian, family member or neighbor who can be contacted if we are unable to reach you. Please state their relationship to the child.Contact 2 Name* First Last Phone for Contact 2*Contact 2's Relationship to Child* Health InformationChild's Doctor Name* Doctor's Phone Number*Allergies or Health Concerns* No allergies or health concerns Yes Please contact the General Manager Rudy Borgueta at 401-846-9410, extension 4, so that he is aware of the medical issue.Additional QuestionsHow would you rate your child's swimming ability?* Excellent Good Fair Poor Does not know how to swim Has your child attended at Newport Yacht Club junior sailing program before?* Yes No Does your child have previous sailing experience?* Yes No If yes, please tell us about their previous sailing experience Adult Sailing lessons*Would you be interested in learning more about Adult sailing classes for yourself? Yes No How did you learn about us?* Newspaper Social Media Friend or Colleague My Child’s school Consent and PaymentParent/Guardian Consent*As the parent/guardian of the named individual for whom application is being made to Newport Yacht Club, I, the undersigned, agree to indemnify and hold blameless the Newport Yacht Club, their officers, directors, members, affiliates, employees and volunteers. I agreePhoto Release*Newport Yacht Club has my permission to use my or my child’s photograph publicly to promote ONLY the NYC Junior Sailing Program. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. I agreeSession Fee Quantity* Price: $550.00 Quantity Total $0.00 Notes for StaffIs there anything you would like the staff to know?Payment Method – PLEASE ONLY HIT SUBMIT ONCE*Please select payment method. If you applied for and were awarded a scholarship, a scholarship code should have been emailed to you **** PLEASE only click “SUBMIT” ONE (1) TIME***** Credit Card Scholarship Code Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Billing Address* Same as home Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Scholarship Code*
