INDIAN HILL SKI CLUB REGISTRATION AND RELEASE FORM
Approved: 2/11/98

[     ] I am currently a member receiving all club mailings and wish to register for:
[     ] I want to become a member, receive all club mailings and register for:
[     ] I am not a member, but wish to participate in:

Club Activity: _____________________________________ Date of Activity: __________________
Participant Name: __________________________________________________________________
Loc/Room(if Lucent/AT&T): _________________ [    ] E-mail or [    ] Fax: ____________________
Work Phone: _____________________________ Home Phone: _____________________________
Home Address: ____________________________________________________________________
Contact in case of emergency: Name: ___________________________________________________
Phone: ______________________________ Relationship: __________________________________
Address: _________________________________________________________________________

In consideration of my being permitted to participate• in the above mentioned activity of the Indian Hill Ski Club, I, for myself, my heirs, legal representatives, and assigns, do hereby release the Indian Hill Ski Club, its officers, organizers, sponsors, members, and participants, from all suits, claims or demands of any kind, which may result from my death, injury, loss or damage of any kind, occasioned by my participation in or transportation to and from said activity. In making this Release, I affirmatively represent that I am familiar with and recognize the hazards and dangers commonly associated with this activity.

I hereby warrant that I am of full age and free to give this release which I have read and understand.••

Signed: __________________________________________________ Date: ___________________
Witnessed by: _____________________________________________ Date: ___________________

ALL PARTICIPANTS MUST INITIAL THE FOLLOWING:

I have read, understand, and accept the Indian Hill Ski Club cancellation policy. __________(initial).

ALL PARTICIPANTS UNDER THE AGE OF 21 MUST INITIAL THE FOLLOWING:

Alcoholic beverages may be supplied by the Indian Hill Ski Club at it’s functions, but these beverages are for persons of legal drinking age, 21 or older, and not for those persons under the age of 21. I am under the age of 21 and agree to not attempt to obtain alcoholic beverages while I am participating in this function. _________(initial).

I, the undersigned, parent or guardian of the person who signed the forgoing release do hereby consent to the same.

Signed: __________________________________________________ Date: ___________________
Witnessed by: _____________________________________________ Date: ___________________

•   Refusal to sign this release disqualifies the applicant from participation in Indian Hill Ski Club Activities.

•• If the above person is not 18 years of age or over, the statement of age should be stricken out, and the parent or guardian should sign where appropriate.

Please forward the signed and completed form to your trip leader

Trip Leader name: __________________________________________________________________
Trip Leader Address: ________________________________________________________________