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Alpine Snow Kids Registration
Form
Please return registration:
UMF Ski Industries
228 Main Street
Farmington, ME 04938
by December 1st
Please make checks payable to Titcomb Mountain
Childs Name:
________________________________________________________________________
Age: __________________________
Grade: __________________________
School:___________________________________________
Teacher: ________________________
Parent/Guardian Name:
_______________________________________________________________
Mailing Address:
_____________________________________________________________________
_____________________________________________________________________
Phone Number:
Home: _____________________ Work: _____________________
E-Mail:
______________________________________________________________________________
Parent/Guardian Name:
_______________________________________________________________
Mailing Address:
_____________________________________________________________________
_____________________________________________________________________
Phone Number:
Home: _____________________ Work: _____________________
E-Mail:
______________________________________________________________________________
Phone #/Location of a parent on Tuesday and Thursday afternoons from 3:00
P.M. - 5:30 P.M.
____________________________________________________________________________________
In Case Of Emergency Contact:
Name: __________________________________________ Phone Number:
_____________________
Information About Your Child
-
Did he/she participate in
A.S.K. last year?
yes
no
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Has he/she ever skied before?
yes no
if yes, for how many yeas?___________
-
Average number of days your
child skis per season __________________________________
-
What ski areas does he/she go
to most often? ______________________________________
-
Participate in a weekend ski
program? yes
no if yes,
where?_______________
-
Has he/she skied at Titcomb
before? yes
no if yes...how many
years? _______
-
At Titcomb he/she can ski in
control on: the main
the bunny the fox
-
Does he/she ski in...
wedge skis parallel raced last
year don't know
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Parents ski?
Mother: yes no
Father: yes no
-
Do your other children ski?
yes no
-
Are you a member of Titcomb
Mountain (Farmington Ski Club)
yes no
-
Are you planning on renting
equipment? yes
no
-
Are you planning on buying
equipment? yes
no
-
Does your child own a ski
helmet? yes
no
-
What other after school
activities does your child participate in such as sports, clubs, or lessons?
_______________________________________________________________________________
-
Anything else special about
your child that we should know?
_______________________________________________________________________________
____________________________________________________________________________________
WAIVER
I agree to hold harmless the Alpine Snow
Kids program, University of Maine at Farmington and Titcomb Mountain against
loss or damage for any injury, illness, or other condition arising from my
child's participation in Alpine Snow Kids. I sign this waiver with the
full knowledge and understanding of the inherent risk involved in alpine skiing.
____________________________________________________________________________________
Name Of Participant
____________________________________________________________________________________
Signature of legal guardian
____________________________________________________________________________________
Printed name of legal guardian
Date__________________
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