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* 1. What is your first name?

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* 2.
What is your last name?

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* 3. What is your disability?

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* 4. In which of the Robie Pierce Regattas will you compete?

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* 5. What role would you prefer for the Robie?

  Skipper Crew AB (Able Bodied)
Women's Invitational
One-Design (Open)

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* 6. If you are racing in the Robie Pierce Women's Invitational Regatta, please let us know if  you will be Skipper or Crew.  Please provide the name of your teammate(s)  if you are coming as part of a team.

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* 7. If you are racing in the Robie Pierce One-Design Regatta, please let us know if you will be Skipper or Crew.  Please provide the name of your teammate(s)  if you are coming as part of a team.

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* 8. Please provide your contact information.

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* 9. Are you affiliated with Burke Rehabilitation and Research or Burke BRAVE?

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* 10. Do you haven any dietary restrictions?

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* 11. We welcome your family to be a part of the Robie Pierce Regatta weekend. There will be up to a $50 food charge if your guest participates in the meals.  Please provide us with your guest's information so we can plan accordingly.  Thank you!

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* 12. We are scheduling a Spectator Boat to watch the races midday on Saturday and Sunday of the regatta. Please let us know the days and their names if anyone is coming with you that may like to have a spot on the Spectator Boat.

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* 13. Will you bring a guide dog?

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* 14. If you are bringing a guide dog, will you have someone to care for your dog while are on the water?

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* 15. Are you fully vaccinated against CoVID-19?

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* 16. By participating in this event and any related activity sponsored, undertaken, administered, managed, or allowed to be conducted by American Yacht Club, the owner, helmsman and each crew member agree, understand and accept, for themselves and their respective successors, assigns, representatives, administrators, executors, agents, heirs or any person acting or purporting to act on their behalf (“Releasors”) that sailing is an inherently dangerous and unpredictable activity due to multiple factors that cannot be anticipated or predicted with certainty, including but not limited to weather, equipment failure or malfunction, and the actions of others on or off the water, injury, sickness and disease (including communicable diseases such as Covid-19).  Releasors also agree, understand and accept that sailing presents inherent risks of serious bodily injury (including permanent disability, paralysis, and death, whether by drowning or otherwise, sickness and disease (including communicable diseases), property damage and other economic loss.  Accordingly, and in consideration for being permitted to enter into and participate in this or any other sailing event sponsored, undertaken, administered, managed or allowed to be conducted by American Yacht Club, Releasors forever release and waive, to the fullest extent allowed by law, any and all claims, actions, accounts, causes of action and choses in action, whether in law, equity or admiralty, that Releasors now have, may have had or may come to have, against American Yacht Club, including its officers, directors, trustees, members, employees, agents, volunteers, staff, committees, and anyone acting on its behalf (“Releasees”), for anything arising out of or relating to Releasors’ participation in such sailing events (including contracting communicable diseases such as Covid-19).  Notwithstanding anything to the contrary, and without in any way limiting or lessening the effect or breadth of the foregoing release and waiver, and solely for the avoidance of doubt and clarification, Releasors agree, acknowledge and understand that this release and waiver applies to any and all claims of any kind at all against Releasees arising out of or relating to injuries, deaths, sickness and disease (including communicable diseases such as Covid-19), damage to vessels or damage to personal property sustained during or as a result of any and all sailing events sponsored, undertaken, administered, managed or allowed to be conducted by American Yacht Club.

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* 17. Please let us know your shirt-size.  Note: these shirts tend to run small so order one size larger.

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* 18. Everyone always wants to know who will be attending the Robies.  May we add your name to the "Look Who's Coming" section of our website?

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* 19. The next section is your medical and emergency contact information.  Please provide as much information as you would like.  This information is to help you in case of an emergency.  Please do respond to each question to finish your registration.  Thank you!

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* 20. Please provide your Emergency Contact Information

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* 21. What is your blood type?

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* 22. Do you have any chronic ailments? Please check all that apply?

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* 23. Do you have any allergies?  Please check all that apply.

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* 24. Date of last Tetanus/Diptheria/Toxoid Shot?

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* 25. Have you received the Hepatitis Immunization?

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* 26. Name and dose of current medications.

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* 27. Physician who conducted your most recent physical examination:

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* 28. I, the undersigned, do hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis or procedure rendered under the general or specific supervision of any member of the medical staff or of a dentist licensed under the provisions of the Stated Education Law and/or Public Health Law of the State and on the staff of any hospital holding a current operating certificate issued by the State Department of Health.  It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power to render care which the aforementioned physician in the exercise of his best judgment may deem advisable.  It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached:

Thank you very much for registering for the 2022 Robie Pierce One Design Regatta!  We will send you a link for payment for the Regatta fees.  We look forward to you attending the Robie!
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