Eden Ski Club 2018 Registration
Student Last Name *
Your answer
Student First Name *
Your answer
Gender *
Grade *
Date of Birth *
MM
/
DD
/
YYYY
Student contact email address *
Please use a current email address that you check regularly.
Your answer
Citizen of Canada? *
Travel Document *
To travel to the United States each participant needs to produce an official document. Please select the type that you plan on using.
Travel Document Number *
Provide passport, nexus or birth certificate number
Your answer
Ontario Health Card Number *
Your answer
Health Insurance Company Name *
All students must have Out-of-country medical insurance. (ex. Blue Cross, existing parents health coverage, etc)
Your answer
Health Insurance Company - Phone Number *
Your answer
Health Insurance Company - Policy Number *
Your answer
Parent/Guardian Contact Name *
Frist and Last
Your answer
Parent/Guardian Contact Number *
Your answer
Alternate Emergency Contact Name *
If your parent(s) cannot be contacted in case of emergency - this individual will receive phone call.
Your answer
Alternate Emergency Contact Phone Number *
If your parent(s) cannot be contacted in case of emergency - this individual will receive phone call.
Your answer
What ski pass are you purchasing? *
Equipment Rental (from Holiday Valley) - Helmet
Answer only if you are renting a helmet from Holiday Valley
Equipment Rental (from Holiday Valley) - Ski Package
Answer only if you are renting a ski package from Holiday Valley
Equipment Rental (from Holiday Valley) - Snowboard Package
Answer only if you are renting a snowboard package from Holiday Valley
What do you believe is your level of skiing or boarding ability? *
How many years have you been skiing or boarding? *
List any medical conditions or injuries that should be known by the chaperones. *
Your answer
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