WV Address WV Phone # Father / Male Guardian Information (required) Work Phone # Home Phone # Cell Phone # Home Address (if different)
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1 2016 Freestyle/Freeski BagJump/Trampoline Skills Training Sessions & 6 Day Camp Application For each athlete, please complete, sign and return all pages of this application and include payment in full by check or credit card for the total fees as set forth in the Fee Worksheet, along with a copy of athlete s medical insurance card. By signing this form, you agree to and acknowledge the following: 1. All fees and charges hereunder are non-refundable. No credits given for any unused days. 2. You and/or your athlete(s) are not enrolled until we have received your payment and all applicable forms filled out completely. The information in this application, including your address, will be used for the WVBBTS/SEF mailings, newsletters, distribution lists and other WVBBTS/SEF communication. 3. The undersigned hereby grants Waterville Valley Black and Blue Trail Smashers Snowsports Educational Foundation, Inc. (WVBBTS/SEF) d.b.a. Waterville Valley Academy and WVBBTS/SEF Snowsports Club the right to obtain and/or use my and my child s photograph, digitized image, video and/or voice recording for marketing, public relations, educational and information purposes. 4. WVBBTS/SEF Code of Conduct. Athlete Information Athlete Name Birth Date Gender Current Grade Snowsports Club Sport BBTS FREESTYLE/FREESKI USSA# / FIS# (not required) Athlete and Parent/Guardian Contact Information (Required) Contact information is the same as BBTS season. If not, please fill out below Home Address City State Zip Mailing Address City State Zip Home Phone # Athlete lives with Father Mother Both Guardian Cell Phone # (Required) WV Address WV Phone # Father / Male Guardian Information Name (required) Work Phone # Home Phone # Cell Phone # Home Address (if different) Mother / Female Guardian Information Name (required) Work Phone # Home Phone # Cell Phone # Home Address (if different) 2016 Freestyle/Freeski BagJump/Trampoline Skills Sessions & Camp Fee Worksheet* 3-Day Skills Training Session Memorial Day Weekend May $195.00* 6- Day Camp, July $750.00* 6 Day Camp July with Overnight Option including 6 nights lodging/meals $995.00* 3-Day Skills Training Session Labor Day Weekend September 3-5 $195.00* 3-Day Skills Training Session Columbus Day Weekend October 8-10 $195.00* To reserve your spot, you MUST include payment in full. Total Amount Due *Prices are cash discounted prices. Cash discounts apply to payments made by cash or check. A Convenience fee of 3% will be charged on all payments made via credit card. Checks payable to: WVBBTS, Attn: Rosemary Landi Camps, PO Box 277, Waterville Valley, NH CHECK OFF PAYMENT TYPE: CHECK AMEX DISCOVER VISA MASTERCARD Credit Card Authorization: I authorize the Total Amount Due in WVBBTS/SEF Fees worksheet above, plus a 3% convenience fee, to be charged to my credit card. Name on Card (please print) Exp. Date Card Number CSV # Signature Date Page 1 of 6
2 2016 Freestyle/Freeski Skills Training Sessions & Camp Athlete Health Summary and Medical Release Form This form constitutes a health summary, permission statement and medical release form that must be signed by the parents or legal guardians of the below named athlete ( Athlete ) participating in the program and Athlete. This form must be completed, executed and returned to WVBBTS/SEF with the program Application. Athlete Name Athlete Information Contact #1 Full Name Home Phone Contact #2 Full Name Home Phone Contact #3 Full Name Home Phone Physician s Name Phone Emergency Contacts Relationship Cell Phone Relationship Cell Phone Relationship Cell Phone Emergency Contacts Date of last physical exam Insurance Coverage of Attendee Company Identification # Phone Policy # Expiration Date Athlete Medical Information Medical Conditions & Restrictions (please include any Dietary requirements and or restrictions) Allergies (please include any food allergies) Medication Contact Lenses Yes No Dental Appliances Yes No Date of last tetanus Please send a photocopy of the athlete s medical insurance card (both sides) Page 2 of 6
3 Permission to Disclose Information/Athlete Medical Release The undersigned parents or legal guardians of Athlete hereby authorize the WVBBTS/SEF Snowsports Club and the Waterville Valley Black and Blue Trail Smashers Snowsports Educational Foundation (collectively, WVBBTS ), and/or their respective coaches, employees, agents or other personnel ( WVBBTS Personnel ) to secure any emergency transport, hospital, medical, dental or surgical care, treatment and/or procedures for the above named Athlete. The undersigned parents or legal guardians also consent that in the event of injury to the Athlete, that one of the WVBBTS/SEF Personnel can sign for Athlete to receive care, treatment and/or procedures, under the instructions and directions of the licensed physicians on call at the emergency room of the nearest hospital or emergency facility. One of the WVBBTS/SEF Personnel shall notify one of the undersigned parents or legal guardians of Athlete at the earliest possible time during or after such care, treatment and/or procedures take place. The undersigned parents or legal guardians of Athlete knowingly and voluntarily consent in advance to such care, treatment and/or procedures to encourage the physicians and WVBBTS/SEF Personnel to exercise their best judgment as to the requirements of such care, treatment and/or procedures. The undersigned parents or legal guardians of Athlete specifically indemnify and hold harmless WVBBTS/SEF and the WVBBTS/SEF Personnel from any and all costs arising out of such care, treatment and/or procedure. The undersigned parents or legal guardians of Athlete hereby grant permission for this Health Summary and Medical Release Form to be released to those WVBBTS/SEF Personnel or other appropriate health care providers who may need this information in order to treat Athlete in a medical emergency. In addition, the undersigned parents or legal guardians of Athlete hereby grant permission, in the event of a medical emergency for WVBBTS/SEF Personnel or other appropriate heath care providers to contact Athlete s primary care physician and to obtain access to the Athlete s medical records. Except as provided in this paragraph above, WVBBTS/SEF shall keep this Health Summary and Medical Release Form in confidence. Insurance Requirements WVBBTS/SEF requires that WVBBTS/SEF program participants be covered by a valid and sufficient medical insurance policy. Athlete will provide a copy of his or her medical insurance card evidencing such insurance policy to WVBBTS/SEF for WVBBTS/SEF to keep on file. The Athlete must carry proof of this insurance and have it available at each training session, competition or program session so that prompt medical care can be obtained, if ever needed. Further Agreement The Undersigned have read and understood the Insurance Requirements statement above. The insurance policy listed above meets the requirements of WVBBTS/SEF and will be maintained in force while Athlete is participating in Snow Sports and Program Activities with WVBBTS/SEF. The Undersigned agree that the Undersigned are responsible for any and all medical charges and the Undersigned agree that they will promptly reimburse WVBBTS/SEF for any expenses that WVBBTS/SEF or the WVBBTS/SEF Personnel incur on behalf of the Athlete. Signature of Athlete Printed Name Date Signature of Mother or Legal Guardian Printed Name Date Signature of Father or Legal Guardian Printed Name Date Page 3 of 6
4 WVBBTS/SEF Club Release, Assumption of Risk and Hold Harmless and Indemnity Agreement The undersigned parents or legal guardians of ( Athlete ) and the undersigned Athlete (collectively, the Undersigned ), understand and acknowledge that skiing and Freestyle/Freeskiing in their various forms as well as training, competition, camps, travel to and from such activities and related activities with respect thereto while taking part in the WVBBTS/SEF Snowsports Club training program regardless of the location of such activities (collectively, Snow Sports Activities ) may (i) place Athlete s life, health and physical well-being at serious risk for personal injury or death and (ii) involve many inherent risks, dangers and hazards. These risks, dangers and hazards include, but are not limited to, changing weather and snow conditions, variations in steepness and terrain, natural and man-made obstacles and structures, equipment failure, collision with objects or structures or being struck by skiers/riders or equipment and exceeding Athlete s own abilities. In consideration of Athlete being permitted to participate in the WVBBTS/SEF Snowsports Club training program and participate in Snow Sports Activities at Waterville Valley Ski Area and other locations, the Undersigned, agree to ASSUME ALL RISKS associated with Athlete participating in Snow Sports Activities and other activities while participating in the WVBBTS Snowsports Club training program. The Undersigned also agree to (i) WAIVE AND RELEASE ANY AND ALL PRESENT AND FUTURE CLAIMS, against the WVBBTS Snowsports Club, Waterville Valley Black and Blue Trail Smashers Snowsports Educational Foundation and their respective agents, employees, coaches, directors, officers, owners and volunteers (collectively, WVBBTS/SEF and its Personnel ), due to any cause whatsoever associated with Athlete participating in Snow Sports Activities and other activities while participating in the WVBBTS/SEF Snowsports Club training program and (ii) DEFEND, INDEMNIFY AND HOLD HARMLESS BBTS and its Personnel from any and all PRESENT AND FUTURE CLAIMS, that may occur as a result of Athlete s participation in Snow Sports Activities or other activities while participating in the WVBBTS/SEF Snowsports Club training program. The Undersigned acknowledge that with Athlete as a participant, Undersigned must take an active role in understanding and accepting these risks, conditions and hazards. Signature of Athlete Printed Name Date Signature of Mother or Legal Guardian Printed Name Date Signature of Father or Legal Guardian Printed Name Date Page 4 of 6
5 WVBBTS Code of Conduct You hereby agree that you and any family members participating in a WVBBTS Camp or Program have reviewed the WVBBTS Code of Conduct set forth below and that each such participant hereby agrees to be bound thereby. WVBBTS Snowsports Club athletes are required to abide by the following requirements in their daily conduct: - To adhere to WVBBTS/SEF core values of: Integrity, Teamwork, Learning, and Excellence - Promptness and honesty - Respect for Waterville Valley Ski Area and WVBBTS property and facilities, including without limitation, cleaning up after oneself in the WVBBTS Clubhouse and Competition Center - Respect for official decisions - Support of WVBBTS staff, coaches and teammates - Good manners (including lack of use of profanity), courtesy and thoughtfulness - Positive attitude and outlook - Good sportsmanship - No use of alcohol, tobacco, illegal drugs, controlled substances or intoxicants - Respect for WVBBTS staff, teammates, competitors and members of the Waterville Valley community at large and other communities visited during competitions, camps and programs. - Observation of any additional rules established by WVBBTS coaches from time to time both on and off the hill - Observation of all rules and regulations of Waterville Valley Ski Area and other ski areas where competitions take place - Agreement to help WVBBTS coaches as requested (e.g.-side slipping of course, putting away equipment, etc.) Signature of Athlete Printed Name Date Signature of Mother or Legal Guardian Printed Name Date Signature of Father or Legal Guardian Printed Name Date Page 5 of 6
6 APPLIES TO ALL ATHLETES WVBBTS/SEF Phil s Hill BagJump Training Center, BagJump Airbag and Thomas Barbeau Training Center and Trampolines Release, Assumption of Risk and Hold Harmless and Indemnity Agreement (Complete one form for each athlete intending to use the WVBBTS Phil s Hill BagJump Training Center, BagJump Airbag, and/or Thomas Barbeau Training Center and Trampolines, it being understood that where the athlete is age 18 and older that the names, signatures and references to parent or legal guardian do not apply.) The undersigned parents or legal guardians of ( Athlete ) and the undersigned Athlete (collectively, the Undersigned ), understand and acknowledge that skiing and Freestyle/Freeskiing in their various forms as well as the use of the Phil s Hill BagJump Training Center, BagJump Airbag, and/or Thomas Barbeau Training Center and Trampolines, including without limitation the Freestyle/Freeski and ski training offered or sponsored by Waterville Valley Black and Blue Trail Smashers Snowsports Educational Foundation in which the Athlete is engaged in (collectively, Snow Sports Activities ) may (i) place Athlete s life, health and physical well-being at serious risk for personal injury or death and (ii) involve many inherent risks, dangers and hazards. These risks, dangers and hazards include, but are not limited to, changing weather and snow conditions, variations in steepness and terrain, natural and man-made obstacles and structures, equipment failure, collision with objects or structures or being struck by skiers/riders or equipment and exceeding Athlete s own abilities or failure of the Phil s Hill BagJump Training Center, BagJump Airbag, and/or Thomas Barbeau Training Center and Trampolines and any equipment therein. In consideration of Athlete being permitted to participate in the Snow Sports training activities including the use of the Phil s Hill BagJump Training Center and Thomas Barbeau Training Center and Trampolines, and any of its equipment located at Snow s Mountain in Waterville Valley, NH, and/or the BagJump airbag at Waterville Valley Ski Area, the Snow s Mountain Property or elsewhere, the Undersigned, agree to ASSUME ALL RISKS associated with Athlete participating in Snow Sports Training and Activities and the use of the Phil s Hill BagJump Training Center and Thomas Barbeau Training Center and Trampolines and/or BagJump Airbag and any equipment therein. The Undersigned also agree to (i) WAIVE AND RELEASE ANY AND ALL PRESENT AND FUTURE CLAIMS against Waterville Valley Black and Blue Trail Smashers Snowsports Educational Foundation, Inc., and their respective agents, employees, coaches, directors, officers, owners and volunteers (collectively, BBTS and its Personnel ), due to any cause whatsoever associated with Athlete participating in Snow Sports Training and Competition Activities and use of the Phil s Hill BagJump Training Center, Thomas Barbeau Training Center and Trampolines, and/or BagJump airbag and any equipment therein and (ii) DEFEND, INDEMNIFY AND HOLD HARMLESS BBTS and their Personnel from any and all PRESENT AND FUTURE CLAIMS, that may occur as a result of Athlete s participation in Snow Sports Training and Competition Activities or use of the BagJump airbag, and/or Thomas Barbeau Training Center and Trampolines and any equipment therein. The Undersigned acknowledge that with Athlete as a participant, Undersigned must take an active role in understanding and accepting these risks, conditions and hazards. Signature of Parent or Legal Guardian Printed Name Date Signature of Athlete Printed Name Page 6 of 6
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