Blackjack Sailing

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Pricing:
Camp Fee- $325 per camper
Sponsor a Camper – See Donation Page

Announcement: Still accepting last minute applications for sessions 3 and 4.

Please fill out the application below to apply for our Summer 2017 sessions. If you prefer a paper application, click here to download it and either scan and email it to info@blackjacksailing.org or send it through postal mail to:

Blackjack Sailing
850 Insight Park Ave. Suite 133
University, MS 38677

Parent Information

   Parent Last Name
   Parent First Name
      email
      phone
      address
      city
      state
      zip code

   Parent 2 Last Name
   Parent 2 First Name
      email
      phone
      address
      city
      state
      zip code















   Other emergency conatact

      Name
      phone

Camper Information

   Camper Last Name
   Camper First Name
   Name camper goes by (if different)
      Age
      Date of birth
      Gender
      Grade in school (in the fall)
      T-shirt size
      First Choice Session
      Second Choice Session
      Third Choice Session










Please list any known medical conditions which may preclude the child from participating in sailing.

Please list any known medical conditions which may require consideration in the event of an emergency.

Please list any known allergies.

Does the child have asthma?
YesNo
If yes, does the child carry an inhaler?

Does the child carry an epi-pen?
YesNo

Does the child have diabetes?
YesNo

Please review our policy document here and then check this box to indicate you have reviewed and accept the policies therein.

By checking this box, you indicate that all the information in this application is true to the best of your knowledge.

By checking this box, you authorize Blackjack Sailing to seek medical treatment for your child should the child be in need of treatment.

ELECTRONIC SIGNATURE: Please enter your full name.

Once your application has been submitted, you will be directed to a payment page where you can make your $50.00 deposit payment. If you prefer to pay by check, please make your check out to Blackjack Sailing and put your camper's name in the memo. Payments may be mailed to:

Blackjack Sailing
850 Insight Park Ave. Suite 133
University, MS 38677

Your application will not be considered complete until your deposit payment is received.

 

Blackjack Sailing
850 Insight Park Ave. Suite 133
University, MS 38677

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