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Youth Medical Form

This form must be completed for all participants who are under 18 years of age.

If the person above is not available in the event of an emergency, notify:
In the case of emergency, I understand every effort
will be made to contact me. In the event I cannot be
reached, I hereby give my permission to the physician
selected to secure the proper medical treatment, which
may include hospitalization, anesthesia, surgery or
injection of medication for my son/daughter. By placing
my initials in this box I agree to the statements.
past or present information / check all that
apply and provide necessary details
please check all that apply and provide necessary details
such as orthopedic or handicap devices,
glasses or contacts, dentures
* indicates required information

First Name: (you must leave this field blank)
Last Name: (you must leave this field blank)

P.O. Box 2424, Nantucket, MA 02584
NCS Office: 508-228-6600 | Jetties Sailing Center: 508-228-5358
info@nantucketcommunitysailing.org
© 2019 Nantucket Community Sailing, a 501(c)(3) non-profit organization