Captain's Name: (if different from above)

D.O.B:

Home Address: City: State:

Cell Phone: Work Phone: Home Phone:

Email Address:

Charter Vessel :   Date of Charter: [ex. 4/01/07 - 04/12/07]

Do you plan to board the night before? [Check if yes]

BOAT OWNERSHIP HISTORY

Boat 1

Period Owned : (ex: 4/89 - 8/94)

Vessel Type:   Size:    Propulsion:

Area of Operations:

BOAT 2

Period Owned : (ex: 4/89 - 8/94)

Vessel Type:    Size:    Propulsion:

Area of operations:

BOAT 3

Period Owned : (ex: 4/89 - 8/94)

Vessel Type:    Size:    Propulsion:

Area of operations:

CAPTAINS CREDENTIALS

Formal Training & Credentials:

CAPTAIN'S CHARTER AND VOYAGE HISTORY

History 1

Year:    Type of Vessel:

Area of Navigation: (inland, coastal, offshore

Duration of Voyage:

Name of Charter Company:

History 2

Year:    Type of Vessel:

Area of Navigation: (inland, coastal, offshore

Duration of Voyage:

Name of Charter Company:

History 3

Year:    Type of Vessel:

Area of Navigation: (inland, coastal, offshore

Duration of Voyage:

Name of Charter Company:

If you have never formally chartered before, please list the boats where you were the skipper(where you have been the sole person responsible for the navigation and safety of he vessel), and the duration and nature of the cruise, the location and the dates.

Where have you done the majority of your sailing?

Are you familiar with the Rules of the Road, Colregs, and Inland Rules?(please explain)

Are you familiar with Aids to Navigation?(please explain)

Are you familiar with the use of a VHF radio?(please explain)

Are you able to plot navigational courses and then accurately sail those courses in order to reach a destination in limited visibility?(please explain)

Are you able to determine a vessel's position with the use of visual sighting, charts, and navigational instruments?(please explain)

PLEASE EXPLAIN IN DETAIL YOUR EXPERIENCE AND CAPABILITIES WITH THE FOLLOWING:

A. Maneuvering in:

1. Close quarters and confined spaces as slip-ways:

2. High traffic areas:

B. Docking at:

1. Slip with fixed pilings/floating docks:

C. Anchoring in:

1. Calm conditions/weather:

D. Mooring:

1. Explain:

E. Handing of twin screw:

1. Explain:

If you have ever been involved in a grounding, collision or any other type of incident while skipper of a vessel which resulted in a damage or liability claim, please explain the circumstances

Please list the names with daytime and evening phone numbers of two individuals who can best verify your ability to take full responsibility for the type of boat you wish to charter.

Reference 1

Name:    Daytime Ph:   Evening Ph: 

How is this person in a position to judge your sailing ability?

Reference 2

Name:    Daytime Ph:    Evening Ph:

How is this person in a position to judge your sailing ability?

Please add any additional information ,questions, or special requests here: