EBONY ICE SKI CLUB- REGISTRATION, RELEASE OF LIABILITY & EMERGENCY CONTACT FORM
Name______D.O.B.______
Address______State ____ Zip______
Phone (H) ______(C) ______Member: YES_____ NO______
Please Check: Beginner: ___ Intermediate: ___Advance: ____ Skier: ____Snowboarder: _____
Parent(s) Name______
Email Address______
Emergency Contact (Parent/Guardian Name) ______
Phone (H) ______(C) ______
Insurance Provider______Group #______
Member Name______Member #______
Allergies______Medication ______
Responsibility: The Ebony Ice Ski Club act only in the capacity of agent to the passenger in all manners pertaining to accommodations, activities and transportation whether by airplane, bus or automobile and as such, shall not be liable for any injury, damage, loss, accident, delay, or irregularity which may be occasioned either by reason of any defect in any vehicle or through the act of default of any company or person engaged in conveying the passenger, or in carrying out the arrangements of the tour, or otherwise in connection therewith. The passage contract in use by the airline and or other transportation company concerned when issued shall constitute the sole contract between the airlines and/or other transportation company and purchaser of this tour and/or passenger.I have received, read and I understand and accept the Ebony Ice Ski club trip policy.
LIABILITY RELEASE:
In consideration of receiving permission to participate in Ebony Ice Ski Club and/or affiliated Ski Club activities, and of receiving permission to participate in any race or other Ski Club activity, on trip(s), receipt of such permission being hereby acknowledged, and doing so upon my own initiative risk and responsibility and being duly aware of the risks, and hazards inherent in such activity, do hereby, for myself and for my heir, executors, and administrators release and forever discharge the Ebony Ice Ski Club and/or affiliated Ski Club and all of its officers and member agents acting officially or otherwise, from any and all claims, demands, or actions on account of my injury, death, or on account of damages which may occur to my property while on said trip(s), or en-route to and from said trip(s). In signing the foregoing release, I hereby acknowledge and represent: (A) that I have read the foregoing release, I understand it, and sign it voluntarily; (B) that I am over twenty-one (21) years of age and of sound mind; (C) that I have read the Ebony Ice Ski Club’s trip application form completely, understand it and agree to the terms thereof. Ebony Ice Ski Club is authorized to use the likeness of myself and family in all markets, manner, formatsand media, now or hereafter developed, throughout the world.
Signed______Date: ______
If under 21 Parent Signature required