Application Form | Sailing and boating on Burlington Bay

Title

First Name*

Last Name*

Address*

Address 2

City*

State/Province*

Postal Code*

Email Address*

Confirm Email Address*

Phone*

Emergency Contact Name*

Emergency Contact Phone Number*

Were you a member of the Mentored Sailing Program last year?*

Yes

No

Do you have any medical issues BS&BC should be aware of to ensure your safety while you are sailing?*

yes

no

If yes, please specify the medical issues

Type of Membership (see below for more information)*

Intermediate Member $450 (plus HST) + 10 volunteer hours

First Mate (family member) $340 (plus HST) + 10 volunteer hours

Senior Mentored Sailing $350 (plus HST)

If you selected First Mate, what is the Intermediate Member's name?

Please tell us about your Sailing Experience?*

How did you find out about BS&BC's Mentored Sailing Program? Do you know someone at the club?*

Why have you chosen the BS&BC Mentored Sailing Program? *

Are you planning on purchasing a boat in the near future?*

Yes

No

Not sure

Which sailing or first aid certifications do you have?

Pleasure Craft Operator Card (PCOC)

Restricted Radiotelephone Operator’s Certificate (ROC)

First Aid certification

Other

If "Other", please specify

What are yiour volunteer skills and/or interests*

If "Other", please specify

Do you have any questions or comments?

Liability Waiver: I agree to release and save harmless the Corporation of the City of Burlington, the Corporation of the City of Hamilton, the Regional Municipality of Halton, the Hamilton Port Authority, the Burlington Sailing and Boating Club and the LaSalle Park Marina Association, including any of their contractors, subcontractors, employees, helpers, officers or members from any and all claims whatsoever associated with the personal injury, loss, damage or destruction to personal property, however caused, during any part of the operations of BSBC Mentored Sailing/Shark Program.*

Yes

Agility Assessment: I agree that BS&BC mentors will do an agility assessment when you are moving around on the sailboats in the first weeks of the program. If it is determined that there is a risk for safety to you or others on board, BS&BC reserves the right to end your mentored sailing program and refund any paid fees.*

Yes

Mentored Sailing Program Application Form 2023