Blue Knob Snow Sports Club, Inc Registration Form 2018/2019 Ski Season

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Mitchell Jacobs
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1 Registration Information: 1. All participants should be at least 8 years of age (Category U10) by Dec 31 st Intermediate skiing skills are necessary (parallel turns on most slopes). 3. Participants must be able to ride a chair lift without assistance. 4. Use of approved ski helmet and medical alert label are required. 5. USSA and PARA Membership is required for ALL individuals planning to race. a. Please apply on-line at b. PARA membership will now be completed as part of the USSA membership. When you renew your USSA membership on line make you choose Pennsylvania and your state and Blue Knob as your Club. USSA will collect and distribute the PARA dues. 6. Registration deadline for the Blue Knob Snow Sports Club is December 17 th, Applications received after that time will be subject to a $35.00 late registration fee. If you have questions, please call Jon Bowser (814) or 4jon.bowser@gmail.com. 7. Fees do not include lift pass. 8. Parent Volunteer Participation we need everyone s involvement. Registration Fees: 1. Christmas Camp Only*: December 26 th to December 30 th $ Ski Development**: Non Racing Member- Christmas Camp plus Weekend Training $ Racer** : All training above plus race days $ a. * BKSSC s ability to conduct the scheduled training session is dependent on variables beyond our control including weather and access to Blue Knob Ski Resort facilities. Should Christmas Camp be canceled in its entirety those participants who registered for the Christmas Camp Only will receive a full refund. BKSSC will attempt to make up missed camp sessions and practices as practical for Ski Development and Racer participants, therefore no refunds will be issued for these full season registrations. b. ** BKSSC will likely not conduct Weekend Training on Race Days for the Western PARA Racing Schedule for Ski Development and Racers not participating in the races. If coaching coverage is available for training at Blue Knob on race dates the coaching staff will communicate the schedule to athletes and parents. Racer Information: Racer s Name Sex D.O.B Particpation Level 1, 2, or 3 Fee Total Fee $ Please make checks payable to Blue Knob Snow Sports Club Race and State Championship Information: 1. BKSSC will provide the required Coaching at no additional cost for all PARA Western Division Races as part of the Racer registration fee. Page 1 of 8

2 2. Parent/Gradian should plan to accompany racers at PARA events to assist coaching staff and volunteer for race official positions if possible. 3. BKSSC does not guarantee the required Coaching at all PA Cup and State Championship race events. However, several options are available to parents to ensure your racer can participate in these events. Please coordinate with the BKSSC head coach to discuss an option for coach coverage for these events prior to registration. a. A Parent/Coach may already be planning to attend the same event for another racer and will provided coaching at no addition charge. Please contact BKSSC head coach for more information about becoming a volunteer Parent/Coach yourself. b. A BKSSC Coach can be hired at a cost of $100/day plus lodging/travel expenses if applicable. Coach will provide the required representation at the event and on-slope coaching to the participant during the race event. c. The BKSSC head coach can attempt to coordinate with another race program s director to provide the required representation at the event free of charge. However, the parent/guardian will be responsible to assist the racer during the event since no on-slope coaching may provided by the other program s coaching staff. Family Information: (please print legibly) * address is for BKSSC correspondence only and will not be sold Father's Name : Address: Daytime Phone: ( ) _- Cell Phone: ( ) - *: Mother's Name : Daytime Phone: Address: Daytime Phone: ( ) _- Cell Phone: ( ) - *: BKSSC Medical Treatment Authorization and Emergency Contact Information : Racer #1: Birth date: Racer #2: Birth date: Racer #3: Birth date: Racer #4: Birth date: Health Insurance Company and Policy Number: Contract ID of Policy Holder: Name of Physician: Address: Telephone Number: Preferred Hospital: City: Emergency Contact #1, Name: Relationship: Daytime Phone: ( ) - Cell Phone: ( _) - Page 2 of 8

3 Emergency Contact, #2, Name: Relationship: Daytime Phone: ( ) - Cell Phone: ( ) - Page 3 of 8

4 Please identify the following for each racer if applicable: Medical Conditions: Allergies: Daily Medications: Does skier wear contacts/glasses: Y or N Other Pertinent Information: I hereby authorize a representative of the Blue Knob Snow Sports Club to sign for my son or daughter for the administration of medical and/or surgical treatment and to assume responsibility for his or her care in the event of an emergency and the parent or guardian cannot be reached. The Club representative has the right to authorize the physician in charge of his/her care to administer any treatment or to administer such anesthetics and to perform such operations as may be deemed necessary and advisable in the diagnosis and treatment of this patient. Date: Signature: (Parent or Guardian) Page 4 of 8

5 Code of Conduct Each racer and a parent must sign the following code of conduct as part of Registration. As a member of the Blue Knob Snow Sports Club, you will be a highly visible representative of the club. It is important that you conduct yourself in a safe, mature and responsible manner at all times. Any failure to do so will only serve to provide the general public, and the Blue Knob ski area management with a negative image of the club, its members, coaches, officers and parents. To ensure your understanding of and willingness to act in a safe and responsible manner at all times, please read and sign the Blue Knob Snow Sports Club Code of Conduct. As a member of the Blue Knob Snow Sports Club, I agree to: 1. Be on time for all Team activities at the designated meeting place. 2. Wear a protective ski helmet during all training and racing sessions. 3. Listen and be courteous and respectful to all coaches, ski area employees/lift attendants, ski patrol, and safety staff. 4. Treat teammates with courtesy, respect and in a manner in which I want to be treated. 5. Treat all other skiers with respect. 6. Respect the race mountain facilities at all times. 7. Ski under control at all times. 8. Be properly dressed. 9. Use only acceptable language at all times. 10. Help the coaches when asked. 11. Do my best in each and every activity. Racer #1 Signature Racer #2 Signature Racer #3 Signature Racer #4 Signature Parent Signature Page 5 of 8

6 BLUE KNOB SKI RACE CLUB RELEASE AND INDEMNITY AGREEMENT I, the undersigned, acknowledge that skiing and snowboarding in their various forms including but not limited to alpine, nordic, and freestyle and dry land training activities are action sports carrying significant risk of serious personal injury, death or property damage. I also know that there are natural, mechanical, and environmental conditions and risks, which independently or in combination with my or my minor child s activities may cause property damage or severe, even fatal injuries to me, my minor child, or others. I agree that I alone am responsible for: (a) my or my minor child s safety while participating in competitive events and/or training for competitive events and (b) providing, utilizing and maintaining that equipment necessary for the safe enjoyment of my or my minor child s participation in such events and specifically acknowledge that the following persons or entities including Blue Knob Snow Sports Club, Inc., Blue Knob Recreation, Inc., the promoters, sponsors, organizers, promoter clubs, officials and any agent, representative, officers, directors, employees, members or affiliates of any person or entity named above are not responsible for my or my minor child s safety. I SPECIFICALLY AGREE NOT TO SUE AND TO RELEASE in advance, Blue Knob Snow Sports Club, Inc. and Blue Knob Recreation, Inc. from any liability whether known or unknown even if liability may arise out of negligence or carelessness or other type of conduct on the part of persons or entities mentioned above. I agree to accept all responsibility for the risks, conditions and hazards, which may occur whether they now are known or unknown. Being fully aware of the risks, conditions and hazards of the proposed activity as a competitor, parent, coach or official, I HEREBY AGREE TO WAIVE, RELEASE AND DISCHARGE any and all claims for damages for death, personal injury or property damage which I may have or which may hereafter accrue to me as a result of any participation in competitive events or training for competitive events, against any person or entity identified above whether such injury or damage was foreseeable or not, including any such claims regarding the design or condition of any equipment utilized by me or my minor child in such competitive events without regard to whether such equipment is specified or recommended by such persons or entities identified above. I further agree to forever HOLD HARMLESS, INDEMNIFY AND DEFEND all persons and entities previously released, generally and specifically from any and all liability for death, personal injury or property damage, resulting in any way from MY OR MY CHILD S participation in competitive events or training for competitive events, regardless of any negligence on the part of the same. I further understand and agree that if I so desire, I or my minor child may pre-inspect any slope, course or other area in anyway related to my or my minor child s participation, prior to my or my minor child s use of the same and that by participating, I AM ASSUMING FOR MYSELF AND MY MINOR CHILD ALL OF THE RISKS INVOLVED. I currently have, and agree to maintain throughout the time that I or my minor child train and compete, valid and sufficient medical and accident insurance. I understand that this is my sole responsibility and release all persons and entities identified above from providing this coverage for me. I agree that I, or my minor child, will accept and abide by the rules and regulations of the Blue Knob Snow Sports Club, Inc., Blue Knob Recreation, Inc., and any other rules or regulations imposed by the organizers of any particular competition. Additionally, I hereby grant permission to the ski club to use my photograph, videotape, motion picture, or other record of my use of the facility, for any legitimate purpose and hereby release all rights to the same. I have carefully read and understand this agreement and all of its terms. I understand that this acknowledgement and assumption of risk may affect legal claims for damages in the event of my, or my minor child s, death, or any injury. I nevertheless enter into this agreement freely and voluntarily and agree that it is binding upon me, my heirs, assigns, and legal representatives. I agree that the terms of this agreement will be binding upon me and shall be governed by the Laws of the Commonwealth of Pennsylvania and that the terms of document shall be admissible in evidence as a binding legal document between the Participant (named below) and Parent/Guardian (named below, if applicable). Page 6 of 8

7 The participant or purchaser of the program voluntarily assumes the risk of injury while participating in this sport. I, THE UNDERSIGNED, HAVE READ, UNDERSTAND AND AGREE TO BE LEGALLY BOUND BY THE RELEASE AGREEMENT ABOVE. Racer #1 Signature and Date Racer #2 Signature and Date Racer #3 Signature and Date Racer #4 Signature and Date Parent Signature and Date (The signature of one parent/guardian binds both parents/guardians, in reference to this agreement) Page 7 of 8

8 Blue Knob Snow Sports Volunteer Program Blue Knob Snow Sports Club, Inc BKSSC can not exist without the help of all its parents! The club strives to establish a healthy and successful race atmosphere for all racers. Therefore, in order to offer your racer the best support for his/her efforts, the BKSSC Board is requiring parent involvement throughout the season in our volunteer program. If volunteer slots need filled, we will call you and expect your help and cooperation. By volunteering, you enrich the lives of not only your child, but all the racers in the club. Some examples of volunteer activities: Committees: 1. Race Committee- Work with Mountain and PARA to help bring a race home to Blue Knob. We need parents to learn all phases of Hosting a Race Event. 2. Fund Raising- Help raise money for equipment. 3. Social Committee(We need to make sure we keep things fun and help develop team camaraderie) Whether you ski or not, if you have a racer, we have a job for you! Please help! Registration Checklist (Please keep this page for your records) To assure your racer(s) is/are properly registered, please check ( X ) the following: Registration Check enclosed ( checks should be made payable to: Blue Knob Snow Sports Club ) Code of Conduct read and signed by both racer(s) and parent Release and Indemnity Agreement signed Medical Treatment Authorization Form completed and signed Upon completing the necessary forms for each racer, please return all above pages to: BKSSC Membership Richard Fiore th Street Altoona, PA Page 8 of 8

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone:

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone: Registration Form Name: Address: City: State: Zip: School: Grade: Grad Year: GPA: HT: WT: Cell Phone: Email: Size: Shirt: Pants: Helmet: Shoe: Jersey #: (List 3 numbers) Parent/Guardian Information Player