Ski/Snowboard Program Registration

$0

Total
Student Name Student Name First Last
Student's Homeroom
Select the sport in which this student will be participating:
Select the student's ability level:
Will this student be renting equipment?
Will this student be taking lessons?
Parent/Guardian Information
Parent/Guardian Name Parent/Guardian Name First Last
Parent/Guardian Email

A confirmation of this registration will be sent to this e-mail address.
Cell Phone, or best number to reach in an emergency Cell Phone, or best number to reach in an emergency - ### - ### ####
Home Phone Number Home Phone Number - ### - ### ####
Work Phone Number Work Phone Number - ### - ### ####
Does your child require any medications such as an Epi-pen or inhaler?

Does your child require any medications such as an Epi-pen or inhaler? Yes No List medications List medications
Other Emergency Contact Name Other Emergency Contact Name First Last
Emergency Contact Phone Number Emergency Contact Phone Number - ### - ### ####
Program Information for Parent/Guardian

Please take time to review the important program information and procedures at http://www.ndatyngsboro.org/activities-camp/ski-and-snowboard-club

By nature, participation in the Ski/Snowboard Program includes risk of injury which may range in severity from minor to disabling to even death. Although serious injuries are not common in this supervised school program, it is impossible to eliminate the risk. Participants can, and have the responsibility to, help reduce the chance of injury. Participants must obey all safety rules, report all physical problems to their chaperones, and take responsibility for the safety of their own equipment.

PARENTS WHO DO NOT WISH TO ACCEPT THE RISKS DESCRIBED IN THESE WARNINGS SHOULD NOT SIGN THIS PERMISSION FORM.

By signing below, I understand that I am granting permission for the above-named student to participate in the Wachusett Ski Program starting January 10,2019 for six Friday afternoons, between the times of 12:15 pm (Dismissal time) and 6:30 pm (Return Time).

I understand that:
- the students will be be transported by bus between the Academy of Notre Dame and Wachusett Mountain.
- faculty members and parent chaperones will be the moderator(s)/supervisor(s) of the program.
- injured students will receive emergency medical care which may become reasonably necessary in the course of ski/snowboard activities and travel.

In consideration of my child’s participation in the Ski/Snowboard Program, I hereby release, save harmless and indemnify the Academy of Notre Dame, its employees and agents from any and all liability for any and all injury sustained by the above-named student in the proper course of ski/snowboard activities or travel. This liability release will not be binding if injury is sustained due to gross negligence on the part of school employees/agents.
If I cannot be reached in an emergency:

If I cannot be reached in an emergency: I hereby consent for qualified personnel to examine, diagnose, and provide treatment including surgery deemed advisable for this student.
By signing this permission form I acknowledge:

By signing this permission form I acknowledge: I accept the risks inherent in my child's participation in the ski/snowboard program at NDA/Wachusett Mtn.
I further acknowledge that:

I further acknowledge that: I have read and agree to all of the above information, including the details found on the Ski/Snowboard Program information page on the Academy website.
Parent/Guardian Signature Parent/Guardian Signature First Last
Date of Signature Date of Signature / MM / DD YYYY
Willing to Chaperone?

Chaperones will be chosen on a "first come - first served" basis with priority given to those that can commit to the entire six week program. Non-skiers and non-snowboarders are welcome!

All Chaperones MUST have completed Virtus training and have submitted a CORI form to the school no later than November 8,2019.
Yes!

Yes! I am interested in being a Chaperone for the 2019 NDA Ski/Snowboard Program
I understand that as a Chaperone:

I understand that as a Chaperone: I must ride the bus to and from Wachusett Mountain, that I must be at NDA by 12:10 pm on ski/snowboard program days.
Chaperone Information

Please note that we will do our best to place your child in your group and have you ride on the same bus as your child, but we can't guarantee placement.
Chaperone Name Chaperone Name First Last
I am available:

I am available: All 6 Weeks As a Substitute on ___________________________________________________
I am a:

I am a: New Chaperone Returning Chaperone
I am a:

I am a: Skier Snowboarder Neither
Chaperone Phone Number Chaperone Phone Number - ### - ### ####
Chaperone Email Address
After clicking Submit below, please wait to be redirected to online payment.
$0

Total

Ski/Snowboard Program Registration

Ski/Snowboard Program Registration

$`0`

Total

Parent/Guardian Information

Program Information for Parent/Guardian

Willing to Chaperone?

Chaperone Information

After clicking Submit below, please wait to be redirected to online payment.

$`0`

Total

Ski/Snowboard Program Registration

Ski/Snowboard Program Registration

$0

Total

Parent/Guardian Information

Program Information for Parent/Guardian

Willing to Chaperone?

Chaperone Information

After clicking Submit below, please wait to be redirected to online payment.

$0

Total

$`0`

$`0`