2023 Historical 10ft Skiff Australian Championship Entry Form

Name of Skiff*

Hull Colour

Sail Design(s)*

Spinnaker Design(s)

Number of extra people travelling with you (for catering purposes)*

Skipper*

First

Last

Date of Birth – Skipper*

Skipper's Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Mobile / Phone – Skipper*

To contact you to clarify your entry if applicable

Email – Skipper*

AS Number – Skipper*

Australian Sailing number

Yacht Club – Skipper*

Do you have any Medical Conditions or Allergies? (Skipper)*

No
Yes

Details of Medical Conditions or Allergies (Skipper)

Please detail any know conditions that may require us to call emergency services for assistance.

Skipper's Emergency Contact*

First

Last

Skipper's Emergency Contact Phone*

Mobile preferred

Skipper's Alternate Emergency Contact*

First

Last

Skipper's Alternate Emergency Contact Phone*

Mobile preferred

Crew Details

Crew 1*

First

Last

Date of Birth – Crew 1*

Address – Crew 1

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Email – Crew 1

Mobile / Phone – Crew 1*

Yacht Club – Crew 1*

AS Number – Crew 1*

Australian Sailing number

Do you have any Medical Conditions or Allergies? (Crew 1)*

Please detail any know conditions that may require us to call emergency services for assistance.

No
Yes

Details of Medical Conditions or Allergies (Crew 1)*

Please detail any know conditions that may require us to call emergency services for assistance.

Crew 1 Emergency Contact*

First

Last

Crew 1 Emergency Contact Phone*

Mobile preferred

Crew 1 Alternate Emergency Contact*

First

Last

Crew 1 Alternate Emergency Contact Phone*

Mobile preferred

Crew 2*

First

Last

Date of Birth – Crew 2*

Address – Crew 2

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Email – Crew 2

Mobile / Phone – Crew 2*

Yacht Club – Crew 2*

AS Number – Crew 2*

Australian Sailing number

Do you have any Medical Conditions or Allergies? (Crew 2)*

Please detail any know conditions that may require us to call emergency services for assistance.

No
Yes

Details of Medical Conditions or Allergies (Crew 2)*

Please detail any know conditions that may require us to call emergency services for assistance.

Crew 2 Emergency Contact*

First

Last

Crew 2 Emergency Contact Phone*

Mobile preferred

Crew 2 Alternate Emergency Contact*

First

Last

Crew 2 Alternate Emergency Contact Phone*

Mobile preferred

Do you have more crew?*

Crew 3*

First

Last

Date of Birth – Crew 3*

Address – Crew 3

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Mobile / Phone – Crew 3*

Email – Crew 3

SA / YNZ Number – Crew 3*

Yacht Club – Crew 3*

Do you have any Medical Conditions or Allergies? (Crew 3)*

No
Yes

Details of Medical Conditions or Allergies (Crew 3)

Please detail any know conditions that may require us to call emergency services for assistance.

Crew 3 Emergency Contact*

First

Last

Crew 3 Emergency Contact Phone*

Mobile preferred

Crew 3 Alternate Emergency Contact*

First

Last

Crew 3 Alternate Emergency Contact Phone*

Mobile preferred

Crew 4*

First

Last

Date of Birth – Crew 4*

Address – Crew 4

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Mobile / Phone – Crew 4*

Email – Crew 4

SA / YNZ Number – Crew 4*

Yacht Club – Crew 4*

Do you have any Medical Conditions or Allergies? (Crew 4)*

No
Yes

Details of Medical Conditions or Allergies (Crew 4)

Please detail any know conditions that may require us to call emergency services for assistance.

Crew 4 Emergency Contact*

First

Last

Crew 4 Emergency Contact Phone*

Mobile preferred

Crew 4 Alternate Emergency Contact*

First

Last

Crew 4 Alternate Emergency Contact Phone*

Mobile preferred

Crew 5*

First

Last

Date of Birth – Crew 5*

Address – Crew 5

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Mobile / Phone – Crew 5*

Email – Crew 5

SA / YNZ Number – Crew 5*

Yacht Club – Crew 5*

Do you have any Medical Conditions or Allergies? (Crew 5)*

No
Yes

Details of Medical Conditions or Allergies (Crew 5)

Please detail any know conditions that may require us to call emergency services for assistance.

Crew 5 Emergency Contact*

First

Last

Crew 5 Emergency Contact Phone*

Mobile preferred

Crew 5 Alternate Emergency Contact*

First

Last

Crew 5 Alternate Emergency Contact Phone*

Mobile preferred

ENTRY DECLARATION

OWNER’S RESPONSIBILITY

The safety of a boat and her crew is the sole and inescapable responsibility of the owner and the person in charge who must do their best to ensure that the boat is structurally sound, thoroughly seaworthy and manned by an experienced crew who are physically fit to face the expected conditions. The owner and the person in charge must be satisfied as to the soundness of the hull, spars, rigging, sails and all gear. The owner and the person in charge must ensure that all safety equipment is properly maintained and stowed and that the crew knows how to use it.

Neither the establishment of the Special Regulations, their use by Race Organisers, or the inspection of a boat under these Special Regulations in any way limits or reduces the complete and unlimited responsibility of the owner and the person in charge.

Entry Declaration*

“I agree to be bound by the Racing Rules of Sailing 2021-2024 and by all other rules, which govern this event, with which I will make myself clear. I acknowledge and understand that the Australian Historical Sailing Skiff Association and the Brisbane 18 Footers Sailing Club, the Brisbane Sailing Squadron, the regatta officials and volunteers do not accept any liability for the loss of life or property, personal injury or damage to property arising out of the championships. I acknowledge that Rule 4 – Decision to Race, places me solely responsible for deciding whether or not to start or to continue racing on the boat.”

On behalf of all crew members, I agree on the date of this application

PRIVACY STATEMENT: The information provided above is for the express purpose of communication between the respondent and the Brisbane 18 Footers Sailing Club for this event and future events of the same nature. The Club will not disclose the information to 3rd party without the permission of the respondent.

Email

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