Club Agreement Form
I am in receipt of the rules for the Ski Club 2008. By signing below I acknowledge that I will comply with all of the rules listed in the Youth to Youth Club Rules and accept any consequences that I might face due to my failure to follow the rules as stated. (Parents and participants must both sign below):
Parent Signature: Date:
Participant Signature: Date:
Name: Grade/Team:______________Birthdate:
Address: City: State:______ Zip:
Parent Names:
Mother: Home Phone: Cell Phone:
Father: Home Phone: Cell Phone:
In case of emergency on FRIDAY NIGHT call first: Phone:
If the above cannot be reached on FRIDAY NIGHT call:
(relative or neighbor) 1. Phone:
2. Phone:
Family Physician: Phone:
Please list any allergies and/or known sensitivities:
PARENT PERMISSION FORM FOR FIELD TRIPS, STUDY-TRAVEL ACTIVITIES AND TRANSPORTATION FOR ACTIVITIES
I/We, the parents /guardians of the student named below, understand the nature of the trip being planned to: ________________________________________ on ________________________________________
Time: Leave 3:30pm Return: 10:45 pm__We understand that the transportation will be by: Coach Tours
And we are in accord with the purposes of and procedures governing the trip. We herby grant permission for our son/daughter to participate. We understand that adequate and appropriate supervision will be provided. We recognize, however, that unanticipated situations and problems can arise on any trip, which situations or problems are not reasonably within the control of the supervising teacher(s) or staff (including volunteers). We further agree to release and hold harmless the Wilton Youth Council and their agents, officers, employees, and volunteers, from any and all liability, claims, suits, demands, judgments, costs, interest and expense (including attorneys’ fees and costs) arising from such activities, including any accident or injury to the student and the costs of medical services.
In the event of an injury requiring medical attention, I hereby grant permission to the supervising teacher(s) or staff (including volunteers) to attend to my son/daughter. If the injury warrants further medical attention, I expect every effort will be made to contact me to receive my specific authorization before action is taken. If efforts to contact me are unsuccessful, I grant permission for necessary medical treatment to be given. In addition, I hereby give my permission to the supervising teacher(s) or staff (including volunteers) to take my child to the physician, dentist, or to the hospital if an accident or serious illness occurs on the trip and i cannot be located.
In the event that a student must return to Wilton independently for reasons of health, accident, failure to conform to rules established by the teacher in charge, etc., we agree to accept full responsibility for and to pay for the cost of medical care, transportation and other incidental expenses.
________________________________ _________________________________ _______________________
Student name (Please Print) Parent or Guardian (signed) Date
Health Insurance Carrier_________________ Insurance Membership Number______________________________