Annapolis Charters
                                                     Annapolis Charters
                                                   Application for Bareboat Charter
                                                (Please Type or Print)

CAPTAIN INFORMATION                                                                         Date: ___________________

Name (Captain): ______________________________________________
Home Address: _______________________________________________
City, State, Zip Code: __________________________________________

Phone Numbers (w/Area Code)
Home: ____________________   Work: ____________________
Cell: _____________________    Other:_____________________

E-mail: ______________________________________________________

CHARTER DATE(S) REQUESTED:

1st Choice: Start Date/Time:
____________/_____am/pm; End Date/Time: _____________/_____am/pm;  Pre-board: Yes___  No___

2nd Choice: Start Date/Time:
____________/_____am/pm; End Date/Time: _____________/_____am/pm;  Pre-board: Yes___  No___

CAPTAIN SAILING EXPERIENCE (Please attach additional sailing information/resume) :

Total number of years sailing experience: ________
Average number of days sailed per year/sailing season: __________

Last Charter:
Company Name:______________________________________________________________
Date _________________________   Location______________________________________
Boat Make:______________________________ Year______________  Size:_____________

Sailboats you have sailed/chartered/owned during the last 3 years:
Make of Vessel; Length; Areas Sailed; Captain/Crew; Owned/Chartered; Name of Charter Company
(1) _____________/ ______ /____________/ ___________/ ______________ / __________________
(2) _____________/ ______ /____________/ ___________/ ______________ /__________________
(3) _____________/ ______ /____________/ ___________/ ______________ /__________________
(4) _____________/ ______ /____________/ ___________/ ______________ /__________________

Sailing/Boating Courses Taken:
Name of Course; Location (City/State); Date/Year Attended
(1) _________________________________/ ___________________________/ _____________________
(2) _________________________________/ ___________________________/ _____________________

Sailing/Yacht Club Memberships:
Name of Club/Organization; Location (City/State); Membership Dates
(1) _________________________________/ ___________________________/ _____________________
(2) _________________________________/ ___________________________/ _____________________


References (Sailing Proficiency):
(Please Print)
Name: ______________________________________        Name:_____________________________________
Address:____________________________________         Address:___________________________________
___________________________________________        __________________________________________
City:___________________  State:____  Zip: _______       City:___________________  State:____  Zip: _______
Home #: _______________Work #________________       Home #: _______________Work #________________

Have you been involved in a boating/sailing accident(s) during the last 3 years?   Yes______   No_______

If “Yes”
, please attach a brief written description and explanation of the accident including the extent of the damage
(cost estimate) to the vessels involved, where, when, and how the accident occurred as well as the weather
conditions and circumstances surrounding the accident.

EMERGENCY CONTACT (Friend/Family Member to contact in case of an Emergency)

Name:____________________________________________  Relationship: ______________________

Address: _________________________________________   Phone Numbers: (w/Area Codes)
_________________________________________________    Home:____________________________
City:______________________________________________  Cell:______________________________
State:__________  Zip:_______________________________  Work:____________________________
Email Address:_______________________________________________________________________

CREW MEMBERS IN CHARTER PARTY (In addition to the Charter Captain)
First Mate  (Please attach First Mate's sailing resume.)
Name:______________________________________      Name:______________________________________
Address:____________________________________     Address:____________________________________
City:__________________State:______Zip:_______       City:__________________State:______Zip:_______
Home Phone:________________________________      Home Phone:________________________________
Boating/Sailing Experience:        Yes___  No___                Boating/Sailing Experience:        Yes___  No___

Name:______________________________________      Name:______________________________________
Address:____________________________________     Address:____________________________________
City:__________________State:______Zip:_______       City:__________________State:______Zip:_______
Home Phone:________________________________      Home Phone:________________________________
Boating/Sailing Experience:        Yes___  No___                Boating/Sailing Experience:        Yes___  No___

Name:______________________________________     Name:______________________________________
Address:____________________________________     Address:____________________________________
City:__________________State:______Zip:_______       City:__________________State:______Zip:_______
Home Phone:________________________________      Home Phone:________________________________
Boating/Sailing Experience:        Yes___  No___                Boating/Sailing Experience:        Yes___  No___


ANNAPOLIS CHARTER'S RELEASE OF LIABILITY AGREEMENT
I/we acknowledge that the Annapolis Charter's Release Agreement (Release Agreement) is part of this Application
for Charter form and agreed to by the above Captain/Crew Members
and/or guests.  To view/read the Release of
Liability
Agreement Click Here.

CHARTER DEPOSIT/FEE/PAYMENT
I have enclosed a deposit of $500.00 with this Application to be applied toward the total Charter fee of
$____________.  The balance of $____________, along with a separate refundable security deposit of $1,500 will
be paid to Annapolis Charters 30 days prior to the Charter start date and the delivery of Smooth Jazz.  
Checks should be made payable to Ralph Johnson.

I understand that in the event of cancellation of the Charter by the Charterer 7 days or less prior to the Charter start
date, the entire Charter deposit shall be retained by Annapolis Charters, and that if cancellation of the Charter by
the Charterer is more than 7 days before the Charter start date, Annapolis Charters shall refund one half of the
Charter deposit to the Charterer.

I also understand that if the instant Application for Charter is not accepted by Annapolis Charters for any reason,
the Charter deposit submitted with the Application shall be returned to the Charter Applicant within 10 business days
of such notification.

I acknowledge that the information contained in this Application may be used for insurance purposes.

The information provided in this Application is true and correct to the best of my knowledge and belief.

Signature________________________________________________      Date_______________________

Please Print Name________________________________________


Mail this completed Application for Charter along with your Charter deposit to:

                     Annapolis Charters
                                                     Attn:  Ralph Johnson
                                                     416 James Court
                                                     Falls Church, VA 22046

Thank you for your interest in Annapolis Charters and chartering Smooth Jazz!
You will be notified by email/phone regarding the acceptance of your Application.

Call Ralph Johnson at 571-276-3568 or Email him at rajohnson10@cs.com if you have additional questions
regarding this Application for Charter and/or chartering Smooth Jazz.







Revised
7/13/2018
Application for Charter
Please Print this Application
and complete by hand.  
Thank you!