Please submit a separate form for each child

Child's First Name: Child's Last Name:

Student's Age (as of July 1st): Select Age Here 6 7 8 9 10 11 12 13   Student's Gender: Select Gender Here Male Female

Parent's First Name: Parent's Last Name:

Street Address:

City:  State:  Zip: *Preference is given to Portsmouth Residents - see comment section

Home Phone number:  Cell Phone number:

Email:

Any Health Concerns: No Yes if yes, please detail in Comment section below

Previous Sailing Experience: None Some       Previous Swimming Experience: None Some

Desired Number of sessions you wish to register for (up to 4): 1 2 3 4

Please Provide (up to 5) the week(s) that you prefer:

Notice: Many weeks are already full (see class descriptions page) so you will not see them listed among the choices here.

Comments: Please provide any additional details, comments that are relevant to PYS including any Health Issues and Resident Status (i.e. grandchild of resident, summer resident, etc.) Additional comments can be emailed to :