Mooring Permit Application Mooring Permit Application To renew your Mooring Permit for the season, please complete the form below. Payment needs to be submitted along with your Insurance Declaration. Name * First Last * Last Membership # Category Mooring # Phone (Home) * Phone (Mobile) * Phone (Local) Email * Yacht Name * Make * Power or Sail? * Power Sail Hull Colour * LOA * LOA: Total length includes bowsprit and any other items protruding from the bow or stern of the vessel Beam * Draft * Registered Name (if applicable) Or License Dinghy Storage Required? Yes No Dinghy Name/Registration Insurance Information Yacht Insurance Company * Policy Number * Insurance Broker/Agent * Liability Amount * Insurance Form on File Insurance Information Complete Expiry Date * NOTE: YOU MUST HAVE A MINIMUM OF $1,000,000 LIABILITY INSURANCE on your boat. You must submit a copy of your Insurance Declaration Page with this Application if we do not have one on file. Fees If you require dinghy storage in addition to your Mooring Permit, click Dinghy Storage fee. A 13% tax is automatically added to your total. Available to Club Members (Temporary, Social or Full) Please contact PEYC and make payment by EMT, credit card, or cheque. Storage Requirement: Mooring Permit Fee - $170.56 Dinghy Storage Fee - $50.00 Total Amount Due Including Tax Sublet Mooring is Sublet Sublet To: Sublet Phone Number PEYC May rent to visitors: Yes No Agreement By applying to renew the permit for my mooring, managed by PEYC, I confirm that I have read and will abide by the Dock & Mooring Policies including the new policies related to Pollution Prevention. With you permission, PEYC will accede to a request from the local PEC MOE and Picton Fire Department for a list of the mooring permit holders' mooring number, owner and boat names and contact phone number, to help them begin an immediate response should they arrive on the scene to address a marine spill in progress. PEYC encourages this, as a fast response to any spill would help mitigate any possible fines and charges to the boat owner and protect the harbour water. quality. Please check the box signifying your agreement to release your information. Yes, I agree to provide my contact information No, please do not include my contact information ** Maintaining the integrity of the mooring is your responsibility. Your signature is required for insurance purposes and to absolve the Prince Edward Yacht Club of mooring-related damages. Signature Clear Date reCAPTCHA Submit
