Registration Form for Silver Run Ski Education Foundation
Summer Camp 2012


Name___________________________ USSA Number______________________
Age___________ Date of Birth_____________   Date_______________

Camp Options: (circle your choice)

  • Full Camp June 10-15 or Half Camp June 10-12; June 13-15
  • Full Camp June 18-23 or Half Camp June 19-20; June 21-23

Will you need lodging?   Yes_____     No ______
Parents' Names_________________________________________________
Mailing Address_______________________ City_______ State____ Zip_______
E-mail Address of parents_____________________________________________
Email Address of athlete______________________________________________
Mother’s Phone Day-(     )________________ Night-(      )_________________
Father’s Phone Day-(    )_________________ Night-(     )_________________
Other Phone Numbers_______________________________________________

Medical Release

We (I)____________________________, the parent (s) or guardian (s) of _________________________________, a minor, entrust such minor into the care of Silver Run Ski Education Foundation adult coach(es) or adult chaperon(s) for those periods of time this ski season when the above-named minor is attending practice sessions or races as a member of Silver Run Ski Education Foundation.  In such connection we authorize such caring adult(s) to obtain medical aid for our son/daughter in case of injury or illness.  It is understood that every effort will be made to contact us if medical attention becomes necessary.

Signature of Parent (s)/ Guardians__________________________ Date_______ ______
                                              ____________________________Date______________

ATHLETE INFORMATION

Allergies __________________________________________________________
_________________________________________________________________
Medication_________________________________________________________
Other Medical Information____________________________________________
_________________________________________________________________

INSURANCE COVERAGE (REQUIRED)

Company Name________________________________ Policy Number________
Insurance Company Phone Number_____________________________________

 

 

Red Lodge International Ski and Snowboard Camp
P.O. Box 2091 Red Lodge, MT 59068
redlodgeracecamp@yahoo.com
406-425-1171

Name________________________ Age_____ Date____________
Address______________________ City____________ State ____
Zip_______ Phone_____________ Email____________________
Circle One: Skier/Snowboarder ½ Day/Full Day Camp: ____________

 

Waiver and Release of Liability

I voluntarily request to participate or to have my minor child participate in ski and/or snowboard activities.  I should not enter and participate unless I am medically able and properly trained.  I agree to visually and physically inspect the area and the adjacent area before using the area.  I know that participating in any snowboarding and skiing event is a dangerous activity.  I accept such risk on behalf of myself and/or my minor child.  KNOWING THESE FACTS, and in consideration of the Red Lodge International Summer Race Camp accepting my entry, on behalf of myself and/or my minor child named on this registration, I EXPRESSLY ACKNOWLEDGE AND AGREE that participating in this event is dangerous and involves the risk of serious injury and/or death.  I, HEARBY, RELEASE, HOLD HARMLESS and INDEMNIFY Red Lodge International Summer Camp, Inc., its shareholders, officers, directors, and employees, the Department of Agriculture, U.S. Forest Service, as well as any event sponsors, from any and all claims of liability for damage or personal injury of any kind or nature whatsoever arising out of or in the course of my participation in this event.  I FURTHER EXPRESSLY AGREE that the foregoing release, waiver, and indemnity agreement is intended to be broad and inclusive as is permitted by the laws of the State of Montana and Wyoming and that if any portion thereof is held invalid, it is agreed that the balance shall notwithstanding, continue in full legal force and effect.  I UNDERSTAND THAT this is a release of liability which will legally prevent me or any other person from filing suit or making any other legal claims against Red Lodge International Summer Race Camp, Inc., its shareholders, officers, directors, and employees.  I or my parent/guardian, nevertheless, enter into this agreement freely and voluntarily and agree that it is binding upon me, my heirs, assigns and legal representatives.  The undersigned further grants full permission to use any photographs, videotapes, motion pictures, recordings or any other record of these events for any purpose.

PARTICIPANTS PERFORMING INVERTED AERIAL MANEUVERS ARE OUTLAWED.

I have carefully read this Waiver and Release of Liability, understand it, and accept its terms.

Participants' Signature:_____________________________Date:_____________

Parent/Guardian Signature:_________________________Date:______________