Community Outreach Sailing

Adaptive Application Form

    This information is to ensure that we may provide you with the best service possible:

    Do you need the assistance of a Hoyer Lift for transference to the boat?


    Parent/Guardian Name (if applicable)
    Parent Phone Number:
    Parent email:
    Emergency Contact:
    Contact Phone #:

    Are you a military veteran
    Do you require a handicap van parking space
    Will you be having a guest or a caretaker join you out on the water
    (If so, please provide additional Release forms for them as well)

    Please type your name as a signature:

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    Click here for Release Form

    Email to schedule.