Titcomb Youth Program Registration Form 2019-2020
Child’s Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Male/Female *
Address *
Your answer
Town *
Your answer
State *
Your answer
Zip Code *
Your answer
Email Address *
Your answer
Parent or Guardian 1 Name: *
Your answer
Parent or Guardian 1 Phone Number: *
Your answer
Parent or Guardian 2 Name
Your answer
Parent or Guardian 2 Phone Number
Your answer
Please indicate any medical conditions we should be aware of:
Medications or Food Allergies:
Your answer
Physicians Name and Phone Number:
Your answer
If in the case of emergency, and I if I cannot be reached. I give permission to Farmington Ski Club and Titcomb Mountain to request professional medical assistance on behalf of my child. *
I am registering my child for the following programs: (check all that apply below)
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Skill Levels and Experience
Has your child ever: *
Never
1 season
2 seasons
3 seasons
4 seasons
5 seasons or more
Downhill skied
Cross/country skied
Snowboarded
Number of years your child has participated in any of the following programs
Never
1 season
2 seasons
3 seasons
4 seasons
5 seasons or more
Alpine Snow Cats;
Buddy Werner;
F.A.S.T - Alpine;
F.A.S.T. Nordic;
Nana Webber - Ski;
Nana Webber - Snowboard;
Saturday Ski School;
Saturday Snowboard School;
Bill Koch-Nordic;
Please check the skill level that best describes your child’s skill ability for each sport they are registered: For example, a child could be a “Beginner Level” snowboard student but an “Intermediate Level” alpine skier. *
First Experience
Beginner
Beginner/Intermediate
Intermediate
Advanced
Downhill/Alpine Ski;
Snowboard;
X-Country/Nordic Ski;
For Alpine programs, please indicate your child’s T-Bar Riding Skills: *
Equipment *
For Bill Koch Program ONLY:
Parent Information:
Parent Information: *
Yes
No
Downhill Experience;
XC Ski Experience;
Waxing Experience;
RECREATIONAL PROGRAMS: All of our programs rely on volunteers. Our after school programs especially appreciate adult helpers. Please indicate how you could help with this program:
Yes
No
Help get the children ready to out out skiing at the beginning of each session (Bill Koch or Nana Webber programs);
Supervise the children who come back to the lodge (Bill Koch or Nana Webber Program);
Ski with a group as a chaperone (instruction provided) (Bill Koch Program);
Instruct a group (training provided);
Help make phone calls to other parents when necessary;
RACE PROGRAMS: All of our programs rely on volunteers. Our after school programs especially appreciate adult helpers. Please indicate how you could help with this program:
Yes
No
Assist with transportation to travel competitions;
Assist with gate keeping on race day;
Assist with technical functions on race days;
Assist with non—technical functions on race day;
Assist with cafeteria on race days;
Assist with the ski-a-then or other fundraisers;
Release of Liability:
I hereby release the Franklin Ski & Outing Club Inc, its members, volunteers or agents, and any person officially connected with the Titcomb Mountain Ski Area, and the Titcomb Mountain Ski Education Foundation from any and all liability for any injury(s) or damage(s) arising from my (or my child’s) participation in Franklin Ski & Outing Club sanctioned activities. Including but not limited to: Nana Webber, Saturday Ski and Snowboard School, Bill Koch, Farmington Area Ski Team (FAST), and Buddy Werner recreational racing programs. I sign this waiver with the full knowledge and understanding of the inherent risk involved in all forms of skiing, snowboarding and all winter activities.
Photo Release:
The Farmington Ski Club may take photographs of groups of children in lessons and programs for program promotions or descriptions. You MUST contact the program directors or Titcomb Mountain Manager if you do NOT want your child photographed.
Type your Name for Liability Statement Above and that all the information in this form is accurate to the best of your knowledge. *
Your answer
I am the parent/or guardian *
Relationship to Child *
Your answer
PAYMENT: (to be mailed)
Please indicate method of payment that will be sent to: Farmington Ski Club, PO Box 138, West Farmington, ME 04992
The method of payment that I will send to Farmington Ski Club, PO Box 138, West Farmington, ME 04992 : *
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