Name  ______________________________________________  Birthdate _______________________________

Address  ____________________________________________  City ____________________  Zip ___________

Phone Number  _____________________________  Yacht Club  _____________________  Fleet  ___________

Email _____________________________________ T-Shirt Size (circle one)Youth Med   Small   Med   Large  XL

Entry Fees made payable to SCYYRA in the amount of $25.00
Entries must be received before registration closes at the Junior Commodore's Regatta on November 6, 2004.

In consideration of your acceptance of my entry I hereby agree as follows:
1. I declare that I am an INSA member in good standing.
2. My yacht will be equipped to conform to all USCG, USSA, and INSA safety requirements.
3. Any contestant may inspect my boat before or after the race.
4. I agree to comply with all Rules and Sailing Instructions governing this event.
5. I hereby release ABYC, MBYC, SDYC, NHYC, SDAYC and INSA, their officers, agents and committee members to or connected therewith, to the extent that such a release does not discharge my insurance carrier under the provisions of insurance policies on my boat. The release includes liability for negligence active and passive and negligent acts and omissions of the foregoing.
6. I assume any risk of injury arising out of my participation in the race, failure or breakage of my boat or any of my equipment, or weather conditions.
7. I certify that I can swim.

Skipper's Signature _______________________________________________________ Date ________________

As a parent/guardian of ___________________________________________________, I hereby agree to his/her entering this regatta under the terms outlined above.

Parent/Guardian Signature _________________________________________________ Date ________________

Mail to:
Robbie Dean
SDYC
1011 Anchorage Lane
San Diego, CA 92106