Exit this survey ISA Optimist Squad Application form 2012-2013 1. Contact Info Question Title * 1. Name of Parent or Guardian Question Title * 2. Name of sailor Question Title * 3. Address Street 1 Street 2 Street 3 Town County Post Code Question Title * 4. Telephone Number Home Mobile Question Title * 5. E-mail Address Question Title * 6. Please fill in the following details on your child Age DOB Height in cm Weight in kg Question Title * 7. Please list the 3 most important overall results you had in the 2012 season? Question Title * 8. I confirm I have read and understood the GUIDELINES FOR SELECTION OF THE ISA Optimist Squad 2012-2013 YES NO Question Title * 9. Please provide the following information Name of school your child attends Which year of school they are in Name of Headmaster Name of Form Teacher Address of School 1 Address of School 2 County Question Title * 10. I confirm I have sent a €500 deposit to Ana Finnegan, ISA, 3 Park Road, Dun Laoghaire, Co Dubline-mail: olympicadmin@sailing.ie Yes No Question Title * 11. I confirm I have sent e-mailed or faxed a copy of my child's PASSPORT to Ana Finnegan olympicadmin@sailing.ie or fax 01 2807558 YES NO Question Title * 12. I confirm I have travel insurance for my child YES NO Question Title * 13. I confirm I have an E111 for my child. YES NO Question Title * 14. I confirm I have sent a completed copy of the Medical Consent form in with this application. YES NO Done