GOOFY (right foot forward). ❑ SPORT SHAPED SKIS ❑ PERFORMANCE SKIS ....
❑hat & gloves. ❑warm clothes (bring layers) ❑warm coat. ❑toiletries (inc. chap ...
REGISTRATION FORM NAME
AGE
HOME PHONE
17-20, 2014 HIGH SCHOOL WEEKEND (GRADES 9-12)
FEBRUARY 14-17, 2014 MIDDLE SCHOOL WEEKEND (GRADES 5-8)
GENDER:
WORK
FATHER’S NAME
PHONE: CELL
WORK
DO YOU NEED A LIFT TICKET?
2.
CONFERENCE COST Circle all that apply
q NEITHER
q yes q no
DO YOU NEED TO RENT EQUIPMENT?
HEIGHT
q yes q no
WEIGHT SHOE
WHAT IS YOUR SKING/ SNOWBOARDING ABILITY?
qbeginner (I)
qmedium (II)
q MALE q FEMALE
EMAIL
PHONE: CELL
WILL YOU BE: q SKING q SNOWBOARDING
JANUARY
q MIDDLE SCHOOL WEEKEND
MOTHER’S NAME
EMERGENCY CONTACT PHONE
Vineyard Youth Conference
GRADE
CELL PHONE
ROOMATE PREFERENCE 1.
2014
q HIGH SCHOOL WEEKEND
qadvanced(III)
SNOWBOARDERS ONLY DO YOU RIDE q REGULAR (left foot forward) q GOOFY (right foot forward)
SIZE
WHITE OUT CONFERENCE TRAVEL TO WHITE OUT LIFT TICKETS Adult Lift Ticket ( 19+) Teen lift ticket ( 13-18) Pre-Teen ticket (7-12) RENTAL EQUIPMENT Shaped Skis & Boots Performance Skis & Boots Snowboard & Boots Helmet rental
SKIERS ONLY WOULD YOU LIKE TO RENT q SPORT SHAPED SKIS q PERFORMANCE SKIS
YOUR TOTAL COST
EXPECT EACH STUDENT TO CONFORM TO THESE RULES OF CONDUCT: No possession or use of alcohol, drugs, or tobacco Respect property No fighting, weapons, fireworks, lighters, or explosives Participation with group is expected No boys in girls’ sleeping quarters or vice versa Respect each other, staff & volunteers
$200 $ $52 $36 $20 $14 $21 $21 $5
$
WE
COST $ #WO2014
No offensive or immodest clothing No students may drive Respect & comply with event schedules
Students who fail to comply with these expectations may be sent home at their parents’ expense. I, the student, have read the rules of conduct, I agree to abide by the stated personal limitations and code of conduct.
STUDENT SIGNATURE
DATE
MEDICAL RELEASE FORM MED ICA L IN SU RA NC E C O MPAN Y PH YSIC IAN
TEAR HERE P OL ICY #
PH O NE
1 . FO R Y O UR CH IL D’S S AFETY & OU R KN OW L ED G E, IS Y O UR CH IL D A q good swimmer q fair swimmer q non-swimmer 2. D OE S YO U R C H ILD HA VE A LL ER G IES TO q pollens
q medications
q food
q insect bites
q other
3. D OE S YO U R C H ILD SU FFER FR O M, O R HA S EVE R E XPER IEN CE D, O R IS B EING TR EATE D C UR RE NTL Y FO R AN Y O F THE FO LL O W ING : q asthma q epilepsy / seizure disorder q heart trouble q diabetes q frequently upset stomach q physical handicap q other:_______________________ 4. P L EAS E L IST AN D E XPL AIN AN Y MA JO R IL L NE SSEE SE TH E C HIL D EXPE RIEN C ED DU RIN G THE LA ST YEA R: 5. D ESC RIB E IN DETA IL TH E N ATU RE A ND SEV ER ITY O F AN Y PH YSIC AL AN D/O R PS YCH O LO G IC AL AIL MEN T, C ON D ITIO N O R LIM ITATIO N TH EY E XPER IEN C E: (p lea se inc lu d e a n y me d ic atio ns an d do sa g es tha t mu st b e tak en ) 7. S H O UL D YO UR CH IL D’S A CTIV ITI ES BE RE STRIC TED FO R A NY R EA SO N? PL EAS E EX PLA IN. Activities may include, but are not limited to: swimming, basketball, roller skating, rollerblading, games in the park, soccer, broomball, ice skating, volleyball, softball, baseball, downhill skiing, snowboarding, hiking, biking, Bible studies. Note: If you desire to limit your child’s participation in any event, please submit your wishes in writing to the church youth pastor prior to that event. has my permission to attend all youth activities sponsored by CANYON VIEW NAME OF STUDENT VINEYARD CHURCH on JAN 17-20, 2014. This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the Church and its staff of any liability against personal losses of named child. I/We the undersigned have legal custody of the student named above, a minor, and have given our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/we also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member.
PARENT/ GUARDIAN SIGNATURE
FRONTIER RANCH
D ATE O F L AST TETA NU S SH O T
DATE
B uil t on t he sid e of the 14, 197 ft. Mt . P rin ceton, our s pect acu lar s et ti ng i nclu des s tun ning view s & rug ged hi gh c liffs . A ll cab in s are ca rpeted and heat ed, a nd t he beds com e w ith linen s so don ’t w orry ab out bringing a s leepin g ba g. A ctivit ies su ch a s the “ Sc ream er”, ou td oor hot sp ring -fed pool , in door gym a nd ga m e room m ak e for a n aw esom e w eek en d ful l of fu n!
PACKING LIST
qbible qtowel qpen & notebook qhat & gloves qwarm clothes (bring layers) qwarm coat qtoiletries (inc. chap stick & sunscreen) qswimsuit (MODEST- no bikinis) qcash for snack shack (optional) qpillow (optional-all bedding is provided by Frontier Ranch) If skiing or snowboarding: qski/ board clothes qski/ board equipment (if you aren’t renting) Absolutely no drugs, alcohol or weapons! You bring all property at your own risk. Canyon View Vineyard Church, Frontier Ranch and White Out staff will not be responsible for lost or stolen property.
EMERGENCY CONTACT FRONTIER RANCH (719) 395-‐4111
