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ST. MARY LIFE TEEN
SKI & SNOWBOARD TRIP 2008
WHO: HIGH SCHOOL TEENS AND FRIENDS
WHEN: SATURDAY, FEBRUARY 9, 2008
MEET AT ST. MARY: 7:00 A.M.
RETURN TO ST. MARY: APPROXIMATELY 1:00 A.M.
PLEASE LEAVE YOUR CAR IN THE LOWER PARKING LOT.
WHAT: SKI & SNOWBOARD TRIP TO PEEK ‘N PEAK, FINDLEY LAKE, NY
BASIC COST: $75 (check payable to St. Mary Church)
INCLUDES:
LIFT TICKET
BUS TRANSPORTATION
LUNCH
DINNER
ADDITIONAL EQUIPMENT RENTAL COST:(check appropriate space on application &
add that amount to the basic cost)
$24: Skis, twin tips, or snowboard
Twin tips are the most fun and the easiest for beginner & intermediate skiier
(& experts).
YOU BRING: Extra money for breakfast (if desired), drinks/snacks
Photo I.D. (required for snowboard rental)
EMERGENCY PHONE NUMBERS 440-339-8364 (Ron Nowak’s cell phone)
440-364-1534 (Kelly Faehnle’s cell phone)
DEADLINE FOR APPLICATIONS IS FEBRUARY 1
FEE INCREASES TO $100 AFTER THAT DATE
CHAPERONE INFORMATION
NO COST FOR NON-SKIING/SNOWBOARDING ADULTS WHO WILL
CHAPERONE IN THE LODGE AND HELP PREPARE MEALS, ETC.
CHAPERONES/CORE MEMBERS WILL HAVE A REDUCED COST
IF SKIIING OR SNOWBOARDING.
ALL CHAPERONES NEED TO COMPLETE
ALL REGISTRATION MATERIALS!
SKI & SNOWBOARD TRIP APPLICATION
PLEASE COMPLETE BOTH SIDES OF THIS FORM & INCLUDE CHECK FOR BASIC COST PLUS EQUIPMENT RENTAL COST.
NOTE: ONLY A COMPLETE APPLICATION WILL HOLD YOUR SPOT!
FILL IN ALL SPACES!
A FORM NOT FULLY COMPLETED WILL BE RETURNED TO YOU.
NAME OF PARTICIPANT__________________________________________________
SKIING/SNOWBOARDING CHAPERONE? _______YES _______NO
_________YES, I WILL HELP/CHAPERONE. I WILL NOT BE SKIING OR SNOWBOARDING
EMAIL ADDRESS (PLEASE PRINT CLEARLY)____________________________________
I HAVE ATTACHED MY CHECK (payable to St. Mary Church)
WHICH COVERS THE COSTS BELOW:
EQUIPMENT RENTAL (if applicable)
_________ $24: Twin Tip Skis
_________ $24: Regular Skis
_________ $24: Snowboard
_________ $75 (Basic trip cost)
_________ TOTAL ATTACHED
STATEMENTS OF RESPONSIBILITY
BOTH PARENT AND TEEN MUST SIGN
TEEN: I request to participate in St. Mary LIFE TEEN Ski & Snowboard Trip to Peek ‘n Peak. I understand that by requesting to go, I am promising to abide by all rules, obey all chaperones, and observe check-in times. I also realize that I may not bring or use illegal drugs or alcohol and that I cannot smoke.
TEEN SIGNATURE___________________________________________________Date________________
PARENT/ADULT PARTICIPANT: I request that I/my son/daughter ___________________________ accompany the LIFE TEEN staff and chaperones to Peek ‘n Peak in Findley Lake, NY. My request releases St. Mary Parish of Hudson, Ohio, and the Diocese of Cleveland in case of injury. I support the right of the group’s leaders to send me/my son/daughter home at my expense if given just cause. I understand that this means I would give the Youth Minister my credit card number over the phone in order to authorize purchase of a bus ticket. I also request that the Youth Minister or his designates issue emergency medical assistance, if that should be required.
PARENT/ADULT
PARTICIPANT SIGNATURE________________________________________________Date________________
***************************************************
OFFICE USE ONLY
Amount Pd._________ Date Pd.__________ Check No.__________ App. No._________
HEALTH INFORMATION/MEDICAL RELEASE
Name of Participant______________________________________________________ Year of Graduation____________
Parent/Guardian____________________________________________________________________________________
Address___________________________________________________________________________________________
street city state/zip
PARENTS: WE MUST HAVE A NUMBER WHERE YOU CAN BE REACHED AT ANY TIME:
Home Phone______________________Work Phone_______________________Cell Phone________________________
Emergency Contact ____________________________________________Phone ________________________________
Medical Insurance_________________________Policy #_________________________Phone______________________
ALLERGIES, CONDITIONS, DIETARY RESTRICTIONS, SPECIAL NEEDS, MEDICAL CONCERNS OF WHICH WE SHOULD BE AWARE:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
I DO give permission for the chaperones to seek emergency medical treatment, transportation or medical attention for me (if participant is over age 18) or my child (if participant is under age 18 and I cannot be contacted). I hereby give permission to the attending physician to hospitalize, secure proper treatment for, and to order injection,
anesthesia, or surgery for me/my child. My request releases St. Mary Parish of Hudson, Ohio and the Catholic Diocese of Cleveland in case of injury. St. Mary LIFE TEEN staff and chaperones will not be held responsible or liable for any injury or loss of property.
I
DO NOT give permission for transportation, or medical attention
for me/my child. My request releases St. Mary Parish of Hudson, Ohio and
the Catholic Diocese of Cleveland in case of injury. St. Mary LIFE TEEN staff
and chaperones will not be held responsible or liable for any injury or loss of
property.
___________________________________________________________________Date___________________________
Parent Signature (if participant is under 18) OR
Participant Signature (if participant is 18 or over)