Camper Registration Form

Each camper needs to fill out this form in order to attend. Please have this form filled out at least 1 hour prior to arriving to camp.

In order to ensure a reservation, a $200 deposit is required.

Camper's Name First Last
Session
Years of skiing experience

Skiing experience in years
Friends/Relatives attending camp
Parent's/Guardian's Name First Last
Enter your parent/guardian's name.
Parent/Guardian's Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone - (###) - ### ####
Enter your home phone number.
Mobile Phone - (###) - ### ####
Enter your parent/guardian's mobile phone number.
Parent/Guardian's E-mail

Enter your parent/guardian's e-mail address.
Emergency Contact Number - (###) - ### ####
Enter your emergency contact's phone number.
Do you carry family medical/hospital insurance? Yes No
Click Yes or No.
Name of Person with Insurance First Last
Enter the name of the person whose name appears on your insurance card.
Insurance Carrier

Enter the name of your insurance carrier
Policy/Group Number

Enter your insurance policy/group number.
Family Physician's Name First Last
Enter the name of your family physician.
Physician's Phone - (###) - ### ####
Enter the phone number for your family physician.
Allergies/Special Needs

List any allergies or special needs a camper may have.
Authorization for Treatment: I hereby give permission to the medical personnel selected by the camp director to order X-rays, routine tests, treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for me/or my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, for the person named above. This completed form may be photocopied for trips out of camp.

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