MT HOOD ALPINE ABILITY AUGUST CAMP!! IT IS SLALOM TIME!
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- Rose Pitts
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1 This form needs to be completed by all camp athletes. MT HOOD ALPINE ABILITY AUGUST CAMP!! IT IS SLALOM TIME! Dates: August 13, 14, 15 on snow, August 16 rest day, August 17, 18, 19 on snow Travel by van included: August and August Accomodations included Cost $1,300 Air travel on August 12 and the night of August 19 not included Meals not included Alpine Ability athletes! Come to Mt Hood in August with Team Summit! This is a great chance to get on snow in August at Mt. Hood. Join coaches Erik Leirfallom and Sylvan Kaufman for 6 fun on snow training days for a great start to the 2011/2012 season! Questions? Contact Sylvan Kaufman at Travel with the Team in the van on August and August Air travel on own on August 12, and the night of August 19 Participants Name Date of Birth USSA # Parent Name and Address Phone Number s, Home & Cell Payment: Must be paid in full at time of registration. Please make checks payable to Team Summit. Credit Card: Number Exp. Liability Releases: All participants must sign a Team Summit liability release and accompanying resort liability release. USSA Membership: All participants must have a current USSA membership. Renew your membership now at USSA.org as your card expired June 2011.
2 TEAM SUMMIT 2011/2012 Medical Information Form and Permission to Treat Athlete s Name: Medical Information Family Doctor: Phone #: Address: Describe any medical condition(s) or special medications that Team Summit should be aware of: Allergies: Medications: Permission to Treat Since injuries do occasionally occur in athletics, Team Summit needs your permission to treat your child in an emergency situation. Please fill in and sign the form below. You have my consent to treat in an emergency medical situation. Parent Signature Date Parent s Name Printed
3 Insurance Information Medical Insurance Company: Address: Phone: Policy #: Group #: Policy Holder: Emergency Contact Information Name: Phone #: Address: Name: Phone #: Address: Questions? Please mail or fax your registration to: Team Summit PO Box 3307 Copper Mt, Co Team Summit Fax number
4 2011/2012 TEAM SUMMIT ADULT AND CHILD RACING TEAM ASSUMPTION OF RISK, RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT PLEASE READ CAREFULLY BEFORE SIGNING. THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS. The person who is taking part in race training shall be referred to hereinafter as PARTICIPANT. THE UNDERSIGNED means only the PARTICIPANT when the PARTICIPANT is age 18 or older OR it means both the PARTICIPANT and the PARTICIPANT S parent or legal guardian when the PARTICIPANT is under the age of 18. THE UNDERSIGNED agree and understand that participation in skiing, snowboarding, race training, competition and/or using ski area facilities, including the lifts, for any purposes (hereinafter the ACTIVITY ) can be HAZARDOUS AND INVOLVES THE RISK OF PHYSICAL INJURY OR DEATH. THE UNDERSIGNED are advised that a person using any of the facilities of the ski area is considered a skier. THE UNDERSIGNED acknowledge and understand the following WARNING concerning the dangers and risks of skiing and understand that the PARTICIPANT, as a skier under Colorado law, ASSUMES THE FOLLOWING RISKS: WARNING Under Colorado law, a skier assumes the risk of any injury to person or property resulting from any of the inherent dangers and risks of skiing and may not recover from any ski area operator for any injury resulting from any of the inherent dangers and risks of skiing, including: Changing weather conditions; existing and changing snow conditions; bare spots; rocks; stumps; trees; collisions with natural objects, man-made objects, or other skiers; variation in terrain; and the failure of skiers to ski within their own abilities. THE UNDERSIGNED further agree and understand that risks associated with the ACTIVITY, in addition to those previously listed, include, but are not limited to: marked and unmarked obstacles; rugged mountainous terrain; slick or uneven riding and walking surfaces, surfaces covered with ice and snow; strenuous activity; high altitude; running courses, other training on and off snow, drills and exercises; and free skiing. PARTICIPANT understands and acknowledges he/she has been informed and understands all rules and regulations of participation in the ACTIVITY. Pursuant to Colorado law, PARTICIPANT assumes the responsibility of maintaining control at all times while engaging in the ACTIVITY. PARTICIPANT is responsible for reading, understanding and complying with all signage, including instructions on the use of the lifts. PARTICIPANT recognizes that he/she must have the physical dexterity and knowledge sufficient to safely load, ride and unload the lifts. PARTICIPANT assumes the risks of riding the lifts and engaging in activities accessible from the lifts. THE UNDERSIGNED also understands and agrees that the PARTICIPANT, even if a minor may use SKI LIFTS WITHOUT AN ADULT PRESENT. THE UNDERSIGNED also understand that THE PARTICIPANT MAY ALSO BE ENTERING INTO AND USING THE FEATURES CONTAINED IN TERRAIN PARKS. THE UNDERSIGNED understand that snowmobiles, snowmaking, snow-grooming and ACTIVITY preparation equipment may be encountered at any time. THE UNDERSIGNED recognize that falls and collisions occur and injuries are a common and ordinary occurrence of the ACTIVITY. THE UNDERSIGNED agree with the premise that the PARTICIPANT is a competitor at all times, whether practicing for competition or in competition. THE UNDERSIGNED understand that the PARTICIPANT has the opportunity to inspect the ski/snowboard training course and/or competition course prior to participating in the ACTIVITY and that he/she assumes the risk of all course conditions, including but not limited to course construction or layout and obstacles. RECOGNIZING ALL THE RISKS, PARTICIPANT VOLUNTARILY CHOOSES TO TAKE PART IN THE ACTIVITY. In consideration of allowing the PARTICIPANT to participate in the ACTIVITY, THE UNDERSIGNED hereby agree to ASSUME ALL RISKS associated with the PARTICIPANT S participation in the ACTIVITY. Additionally, THE UNDERSIGNED agree to HOLD HARMLESS, RELEASE, DEFEND, AND INDEMNIFY, TEAM SUMMIT personnel, Arapahoe Basin, Breckenridge Ski Resort, Copper Mountain, Inc., Keystone Resort, Summit School District and Vail Resorts, its affiliated organizations and companies, the United States, and their insurance carriers, their respective agents, employees, representatives, assignees, officers, directors, and shareholders (each hereinafter a RELEASED PARTY ) for ANY AND ALL LIABILITY and/or claims for injury or death to persons or damage to property arising from the PARTICIPANT S participation in the ACTIVITY, including those claims based on any RELEASED PARTY s alleged or actual NEGLIGENCE OR BREACH OF any express or implied WARRANTY. By signing this release, THE UNDERSIGNED AGREE NOT TO SUE any Released Party and agree they are releasing any right to make a claim or file a lawsuit against any
5 Released Party. THE UNDERSIGNED further AGREE TO DEFEND AND INDEMNIFY each RELEASED PARTY for any and all claims of THE UNDERSIGNED and/or a third party arising in whole or in part from the PARTICIPANT S participation in the ACTIVITY. THE UNDERSIGNED understand and agree that at the scheduled end time for coaching, the PARTICIPANT is no longer considered a participant in the racing team program, and if applicable, that the parent or legal guardian is responsible for picking up their minor PARTICIPANT at the allocated time. TEAM SUMMIT is not responsible for accidents that may occur after the completion of training THE UNDERSIGNED represent that the PARTICIPANT is in good health and there are no special problems associated with his/her care. THE UNDERSIGNED authorize any RELEASED PARTY and/or their authorized personnel to call for medical care for the PARTICIPANT or to transport the PARTICIPANT to a medical facility or hospital if, in the opinion of such personnel, medical attention is needed. THE UNDERSIGNED agree that upon PARTICIPANT s transport to any such medical facility or hospital that the RELEASED PARTY shall not have any further responsibility for PARTICIPANT. Further, THE UNDERSIGNED agree to pay all costs associated with such medical care and related transportation provided for PARTICIPANT and shall indemnify and hold harmless the RELEASED PARTY from any costs incurred therein, or any claims originating therefrom. THE UNDERSIGNED agree and understand that this release is applicable to each and every day the PARTICIPANT participates in the ACTIVITY for the 2011/2012 ski season. In consideration for allowing the PARTICIPANT to participate in the ACTIVITY and for using the ski area facilities, THE UNDERSIGNED agree that ANY AND ALL CLAIMS for injury and/or death arising from the PARTICIPANT s participation in the ACTIVITY shall be GOVERNED BY COLORADO LAW and EXCLUSIVE JURISDICTION of any claim shall be in the DISTRICT COURT residing where the alleged incident occurred or in the FEDERAL COURT FOR THE STATE OF COLORADO. In the case of a minor PARTICIPANT, the undersigned parent or legal guardian acknowledges that he/she is also signing this release on behalf of the minor and that the minor shall be bound by all the terms of this release. Additionally, by signing this release as the parent or legal guardian of a minor PARTICIPANT, the parent or legal guardian understands that he/she is waiving certain rights on behalf of the minor that the minor otherwise may have. The undersigned parent or legal guardian agree that but for the foregoing, the minor PARTICIPANT would not be permitted to participate in the ACTIVITY. By signing this release without a parent or guardian s signature, the PARTICIPANT represents that he/she is at least 18 years of age, or, if signing as the parent or guardian of the PARTICIPANT, you represent that you are the legal parent or guardian of the minor PARTICIPANT. This release shall be binding to the fullest extent permitted by law. If any part of this release is deemed to be unenforceable, the remaining terms shall be an enforceable contract between the parties. This release shall be binding upon the assignees, subrogors, distributors, heirs, next of kin, executors and personal representatives of THE UNDERSIGNED. I HAVE CAREFULLY READ THE FOREGOING LIABILITY RELEASE, UNDERSTAND ITS CONTENTS, AND AM AWARE THAT I AM RELEASING CERTAIN LEGAL RIGHTS THAT I OTHERWISE MAY HAVE. Printed Name of PARTICIPANT Signature of PARTICIPANT Date Printed Name of Parent/Legal Guardian #1 Signature of Parent/Legal Guardian #1 Date Phone Printed Name of Parent/Legal Guardian #2 Signature of Parent/Legal Guardian #2 Date Phone Emergency Contact: NAME: RELATION: TELEPHONE:
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