BLANDFORD SKI
TEAM
EMERGENCY
MEDICAL CARE CONSENT
Racer’s
Name____________________________________ Date of Birth_______________
I authorize the
Blandford Ski Club to seek emergency medical care if needed for my
child.
Child’s
Physician___________________________________________________________
Address___________________________________________________________________
Phone #
_________________________________________________________________
Child’s
Allergies ____________________________________________________________
Childs Chronic
Health Condition ________________________________________________
Medications_______________________________________________________________
Emergency
Contacts (in case parents are unable to be reached).
Racer’s Name:
____________________________________
Name___________________________________________
Relationship_____________
Address__________________________________________ Phone
#_______________
Do you give
permission for you child to be released to this person? Yes____ No___
Name____________________________________________Relationship_____________
Address__________________________________________ Phone
#_______________
Do you give
permission for you child to be released to this person? Yes____ No____
Insurance
Information
Racer’s Name:
____________________________________
Health Insurance
Coverage_______________________________ Policy #_____________
Father
_______________________________________ Home Phone _______________
Cell Phone
____________________
Mother
______________________________________ Home Phone _______________
Cell Phone
____________________
________________________________________ _____________________
Parent/Guardian
Signature
Date
Blandford Ski Team
Consent to Participate Form
Racer’s Name :
_______________________________
I give my
approval / consent for the participation of my son / daughter on the
Blandford Skit Team. I am aware of the risks and hazards incidental to
such participation and I certify that he / she is physically fit to take
part in all activities. I will not hold program authorities, staff or
Springfield Ski Club or the Blandford
Ski team
responsible in the case of accident or injury as the result of his / her
participation. Permission is granted for the applicant to be given
treatment by Ski patrol or at a local hospital and I will assume all
responsibility for payment to said institution. I also grant program
literature or publicity to promote said ski team. I pledge his / her
compliance to all program rules and understand that should he / she be
dismissed from the Blandford Ski Team for any conduct not in the best
interest of the program. No part of the registration fee will be
refunded.
_________________________________________ _______________________
Parent /
Guardian Signature
Date
Skiers are
occasionally photographed and video taped as part of training. Do you
give permission for Blandford Ski Club to use these on their website or
for other promotional purposes.
Yes: _____ No:
_______
_________________________________________ _______________________
Parent /
Guardian Signature
Date
Volunteer
Interest
In order to run
a smooth season the Blandford Ski team needs volunteers from time to
time to assist with running Club, Interclub and Tri-State events. We
know everyone has different commitments and may not always be available.
To assist us in our planning this season please indicate where you may
best be suited and are willing to assist.
____ Organizing
/ Planning Team Picnic (s)
____ Race
Registration (being at the Mt by 7 am morning of Race)
____ Score
Keeper &/or Score Board recorder
____ Gate Keeper
____ Designated
Parent Mentor (Interclub)
____ Timing
Committee (This will require the ability to attending several workshops)
____ Emergency
Phone Chain Leader (s)
____ Race Team
Lodge Cleaning Committee
____ Video
Photographer for occasional practice
____ Assisting
setup/take down of course for Races only
____ Club Race
Registration
____ Other……
