Ski Trip Registration Form

Name

First NameLast Name

Gender*

MaleFemale

Birth Date*

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone*

Emergency Contact Name(if parent or guardian is not avaliable)

First NameLast Name

Emergency Number*

Year of Graduation*

Grade for 2023-2024 school year*

Cabin Buddy #1

Cabin Buddy #2

Parent/Legal Guardian

First NameLast Name

Relation*

Work Phone*

Cell Phone

Parent /Legal Guardian 2

First NameLast Name

Relation 2

Work Phone 2

Cell Phone 2

Church you attend

Church City

Church you are coming with (if any)

Parents Email (teenager's confirmation will be sent by email, if left blank it will be mailed)

example@example.com

Skier/tuber's Email

example@example.com

Age*

Height*

Weight*

Shoe size*

Activities *

Ski ability*

* selecting beginner means you will be required to attend a training course on the mountain

Gear needs*

Scheduled time*

Please select the time you would like to schedule for tubing if you are

Ibuprofen/Advil*

YesNo

Tylenol*

YesNo

Benadryl*

YesNo

Midol/Excedrin*

YesNo

Tums/Pepto*

YesNo

It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury. If the information has changed on the day of registration please see the retreat nurse at that time. Please bring all medication in the ORIGINAL CONTAINER or you will not be allowed to leave the medication or vitamins at the retreat. No exceptions. All prescriptions must be in that teenagers name and the correct dosage.

Is teenager free from infectious desease or conditions?*

YesNo

Are immunications up to date?*

YesNo

Date of last tetanus shot

Date

All fields are required below. If it does not apply, please type "NONE" in the box. Thanks.

Any activity the teen should be restricted from?*

Any physical, mental or other condition that would require special attention or medication while at retreat?*

List any past medical treatment that would be helpful for us to know.*

List any allergies (ex: bees,peanuts, dairy)*

Any dietary needs that we should know about?*

List all medications, both prescribed and over the counter. All medications will be turned into the retreat nurse except rescue inhalers. Bring all medication in original containers.*

Gear Rental Cost

Skis - $18

Snowboard - $25

Bibs - $10

Coat - $10

Helmet - $10

Boots $10

Teenager Release (List anyone, including parents, to whom your teen can be released.)*

Be certain to enter your email address correctly on the registration form to receive confirmation via email within 2 weeks.

By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named teenager, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named teenager by authorized personnel. I understand that the above named teen will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend ski retreat and participate in all activities. I authorize the church to take pictures and videos of my teen, during activities and sports. My child may recieve any e-mails from the camp.

Signature*

Date of Sign

Date

Ski Trip Registration Form

Skier's/Tuber's Information

Cabin Buddy

Parent or Legal Guardian Information

Church Information

Email Confirmation

Gear Information

Tubing Time

Health Information

Skiing cost

Tubing cost

Housing cost

Teenager Release