2017-2018 WATERVILLE SKI PROGRAM
Participant Information Sheet
Please complete and return to the Recreation Department, 263 Main Street, Winchester, MA 01890.
SKI PROGRAM ______
SCHOOL ______Grade ______
PARTICIPANT'S NAME: ______
ADDRESS:______
PHONE#______ALT./ EMERG. # DURING PROG. HOURS ______
DATE OF BIRTH ______
HEALTH INSURANCE CO. ______
ADDRESS OF HEALTH INSURANCE CO. ______
HEALTH INS. POLICY # ______
NAME OF PARENT/GUARDIAN THAT POLICY IS UNDER ______
ANY ADDITIONAL INFO. ( Health, Allergies, Special concerns, etc.)
______
PLEASE CHECK: SKI ______SNOWBOARD ______
WE NEED CHAPERONES: IF INTERESTED PLEASE CHECK HERE ______
WAIVER INFORMATION
I hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the Town of Winchester and its representatives, the Recreation Department, its officers and employees for any and all injuries suffered by myself or my child at these activities. I acknowledge that these activities have some risk of physical injury which I am willing to assume. I consider myself or my child to be in appropriate physical condition to participate in these activities. I hereby grant permission to the attending physician and his/her staff in charge of above named for anesthesia, medical X-ray, and surgical procedures as may be deemed necessary or advisable. I understand that in an emergency, whenever possible, all attempts will be made to communicate with me prior to use of this permission.
PARENT/GUARDIAN SIGNATURE (Parent/Guardian must sign for those under 18)
______Date:______
Department of Recreation and Community Education
2017/2018 STUDENT/PARENT BEHAVIOR CONTRACT
WATERVILLE VALLEY SKI PROGRAM
Ski Season – 2018
PLEASE RETURN ENTIRE SIGNED FORM TO THE RECREATION DEPT.
The following are the inappropriate behavior guidelines and penalties set by the Recreation Department for the Waterville Ski Program:
Any unlawful and/or dangerous behavior may result in total suspension, without refund, of the Waterville Ski Program; such behavior is as follows, but not limited to:
- Breaking any Federal, State, or Local Laws.
- Possession or any indication of use of any illegal substance. (which includes alcohol, drugs, etc.)
- Participating in behavior that is dangerous to yourself and/or others.
- Destruction or misuse of any facility (at mountain or on the bus).
The Winchester Recreation Department, Waterville Chaperones and Recreation Personnel reserve the right to suspend, without refund, any participant from the entire program due to unlawful, dangerous, or any other behavior deemed inappropriate by the Winchester Recreation Director, Program Coordinator, and/or chaperones.
For personal misconduct, such as disrespect for chaperones and/or peers, the following action will be taken.
First Offense: A verbal warning to both the student and the parents
about the inappropriate behavior.
Second Offense: Supsension for two weeks in the program without
refund.
Third Offense: Suspension of the entire program without refund.
I, as a parent/guardian of ______, understand and approve of the conditions of this contract.
______
Parent/Guardian signature Today's Date Telephone #'s where I can be reached on Thursday Afternoons/Evenings
I, ______, fully understand the above conduct guidelines and
student's name
promise to abide by them. ______/_____ /____
Student Today's Date