2021 Family Emergency Contact Form

The emergency family contact and vital information form is REQUIRED for all students (children and adults) participating in Summer Lessons at Taylor Pond Yacht Club in 2021. The form is suitable for up to three students per family, those with more than three students require a secondary form to be completed. For your convenience, this form can be partially completed and "saved & completed later" using the save button at the bottom of the form.


Family Name

Family Address

Parent/Guardian #1 Contact Information


Parent/Guardian #1 Name
Is it OK to text the parent/guardian #1?

Parent/Guardian #2 Contact Information


Parent/Guardian #2 Name
Is it OK to text the parent/guardian #2?

Additional Emergency Contact Information


Additional Emergency Contact Name
Texting the Emergency Contact
Is it OK to text the emergency contact about the students in this family?
Transport by the Emergency Contact
Does the emergency contact have permission to transport the students in this family?

Family Medical/Doctor Information


Student 1 - Vital Information


Student 1 - Name
Student 1 - 2021 Lessons
MM slash DD slash YYYY
Student 1 - Known Allergies
Student 1 - Current Medications & Dosage
Does the student have permission to arrive/depart unaccompanied by an adult? (drive/bike/walk/boat)
Should there be a limit on physical activities for this student?

Student 2- Vital Information


Student 2
Student 2 - 2021 Lessons
MM slash DD slash YYYY
Student 2 - Known Allergies
Student 2 - Current Medications & Dosage
Does the student have permission to arrive/depart unaccompanied by an adult? (drive/bike/walk/boat)
Should there be a limit on physical activities for this student?

Student 3 - Vital Information


Student 3 - Name
Student 3 - 2021 Lessons
MM slash DD slash YYYY
Student 3 - Known Allergies
Student 3 - Current Medications & Dosage
Does the student have permission to arrive/depart unaccompanied by an adult? (drive/bike/walk/boat)
Should there be a limit on physical activities for this student?


Please share with us any additional information we may need to know about the health and well being of your family members.

Parental Consent Section


Medical Release(Required)
Consent to Medical Treatment(Required)