Titcomb Mt./FSC Youth Program Registration Form 2019-2020 Check your deadlines Please do not use this form for SnowCats or Riders Club; use separate form or contact them directly.

Child’s Name______Date of Birth ______(male/female)______Address ______Town______State_____ Zip ______Home phone ______Grade and Name of School Child Attends: ______E-mail Address ______ Ok to e-mail me for updates & volunteer requests Parent or Guardian Name ______Cell phone/Work phone ______Parent or Guardian Name ______Cell phone/Work phone ______Please circle any medical conditions that we should be aware of: Asthma Heart Disease Convulsions/seizures Diabetes Other ______Please circle and note any allergies we should be aware of: Medications ______Foods______Other______

Physician Name: ______Phone:______

In case of emergency, and if I can not be reached, I, ______, give permission to Farmington Ski Club and Titcomb Mountain to request professional medical assistance on behalf of my child______.

Child is a Ski Club Member? YES or NO I am registering my child for the following programs: *Ask about available Scholarships* (Please circle all programs and any time choices that apply and circle fee due)

Circle if CIRCLE Club Non- CIRCLE applicable- PROGRAM Age Time Member Member ONE day of NAME Group Cost Cost week

Monday 3:45-5:00 Bill Koch – Grade Nordic $25/child $45/child Nordic Skiing K- 8 Only 1/6/20 deadline Saturday Ski School Age Alpine Ski Saturdays Circle One $30/child $125/child

12/27/19 deadline 6 - 18 Only Only 10:00 am or $40/adult includes all day lift pass 11:15 am

Saturday Snowboard Age Snowboard Saturdays Circle One $30/child $125/child

School 8 - 18 Only Only 10:00 am or includes all- day lift pass 12/27/19 deadline 11:15 am B.F.A.S.T Grade Alpine Saturdays 1-2:30 pm $30/child $30/child (revised Buddy Werner) 1-5 Ski only Only No lift pass

Intro to Alpine Racing included

Alpine Ski Monday 4:00 pm to $5 a lesson $5 a lesson Nana Webber- Grade OR Or 5:15 pm After School 3 - 6 65 cap 65 cap Snowboard Tuesday Program F.A.S.T.- Ski Team Grade Alpine only Mondays- After- $75- One Titcomb

4 - 8 Nordic only Thursdays school $110- both Pass 12/1/19 deadline Some Sats Alpine and Required OR Both Nordic Please make checks payable to: Farmington Ski Club, PO Box 138, West Farmington, ME 04992

Date______Cash or Check # ______Amount Paid ______FSC Rep ______

PLEASE COMPLETE OTHER SIDE OF APPLICATION

Skills Levels and Experience Has he/she ever: Downhill skied? YES/NO For _____# of seasons downhill skiing Cross/country skied? YES/NO For ______# seasons x-country skiing Snowboarded? YES/NO For______# seasons snowboarding

Please write the number of years your child has participated in any of the following programs: Alpine Snow Cats____yrs Nana Webber-Ski____yrs Nana Webber Snowboard____yrs Buddy Werner____ yrs Saturday Ski School____yrs Saturday Snowboard School____yrs F.A.S.T.- Alpine____yrs F.A.S.T. Nordic____yrs Bill Koch-Nordic____ yrs

Please circle the skill level that best describes your child’s skill ability for each sport that they are registered. For example, a child could be a “Beginner Level” snowboard student but an “Intermediate Level” alpine skier. Downhill/Alpine Ski Snowboard X-Country/Nordic Ski First experience First experience First experience Beginner Beginner Beginner Beginner/Intermediate Beginner/Intermediate Intermediate Intermediate Intermediate Advanced Advanced Advanced

For Alpine programs, please circle your child’s T-Bar Riding skills. T-Bar Skills: Never ridden Only with an adult Can ride with a buddy Can ride alone Other information Please circle one of the following choices for equipment: Own Equipment Renting/leasing For Bill Koch Program: Circle one. My child has: Waxable Skis No-wax Skis ______Parent/Guardian skiing experience (X-C or downhill, also any waxing experience) ______All our programs rely on volunteers. Our after school programs especially appreciate adult helpers. Please indicate how you could help with this program: Recreational Programs ____I will help get the children ready to go out skiing at the beginning of each session. (Bill Koch or Nana Notice: Webber program) ____I will help supervise the children who come back to the lodge. (Bill Koch or Nana Webber Program) The Farmington Ski Club may ____I will ski with a group as a chaperone (instruction provided). (Bill Koch program) take photographs of groups of ____I will help instruct a group (Training on instruction provided). ______program children in lessons and programs ____I will help make phone calls to other parents when necessary. for program promotion or ____I will______. descriptions. You MUST contact Race Programs the program directors or the ___I will assist with transportation to travel competitions Titcomb Mountain Manager if you do NOT want your child ___I will assist with gate keeping on race day photographed. ___I will assist with technical functions on race days ___I will assist with non- technical functions on race day___I will assist with cafeteria on race days______I will assist with the ski-a-thon or other fundraiser 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.

Signed: ______Date: ______Parent or Guardian

Printed name : ______Relationship______