City of Rockville Department of Recreation & Parks

Rockville High

School Ski and

Snowboard Club

2015-16 Season

Information

Packet

Skier / Snowboarder Responsibility Code

Snow sports can be enjoyed in many ways. At ski areas you may see people using alpine, snowboard, telemark, cross country and other specialized ski equipment, such as that used by disabled or other skiers. Regardless of how you

decide to enjoy the slopes, always show courtesy to others and be aware that there are elements of risk in skiing that common sense and personal awareness can help reduce. Observe the code listed below and share with other skiers the responsibility for a great skiing experience.

Always stay in control.

People ahead of you have the right of way.

Stop in a safe place for you and others.

Whenever starting downhill or merging, look uphill and yield.

Use devices to help prevent runaway equipment.

Observe signs and warnings, and keep off closed trails.

Do not go down slopes that are too difficult for your ability

Know how to use the lifts safely.

KNOW THE CODE. IT'S YOUR RESPONSIBILITY.

This is a partial list. Be safety conscious.

______________________________________________________________________________

CONSIDER WEARING A HELMET! It’s a SMART idea!

There is no substitute for responsible behavior on the slopes.

Follow the “Responsibility Code,” and consider wearing a helmet.

SKI CLUB 2015-16 FORMS CHECKLIST

Complete City of Rockville Recreation (bus transportation) Registration Form

Transportation Check : Made out to City of Rockville

Complete Night Club Card online registration & Payment: https://sales.skiliberty.com/webwaresales/grplogin2.aspx

Night Club (NCC) Liability Release Form (Signed by parent and participant)

Photo ID (1-1/2” x 2-1/2” full face image, stapled to front of NCC Release Form or

attached online)

Complete RHS Ski & Snowboard Club Parent Permission Form (Signed by parent)

Complete City of Rockville Participant Information Form: Emergency & Health History/Discipline procedures/ release for

photo & movie Form (signed by parent)

Receipt of payment returned to you

City of Rockville

Department of Recreation and Parks

Rockville High School Ski Club – 2015-16

Rockville Ski & Snowboard Club is looking for a few good skiers and boarders! You do not want to miss out on a great opportunity to learn how to ski / snowboard or improve your skills.

RHS is offering the night club card along with 6 rounds of transportation. We are planning bus trips on the following dates:

January 15th, 2016 (Liberty) February 5th, 2016 (Roundtop)

January 22nd, 2016 (Roundtop) February 12th , 2016 (Whitetail)

January 29th, 2016 (Whitetail) February 19th, 2016 (Liberty)

The bus will leave Rockville High School at 2:30pm on these Fridays and will return at 12:00am.

City of Rockville – Transportation Package

Course #53912 $255.00

Please submit the attached registration form to register. MAKES CHECKS PAYABLE TO City of Rockville

(MC/Visa are also acceptable forms of payment)

Any questions please contact: Mr. Rea, Rockville Ski Club Director at 301-517-5527

City of Rockville Fall 2015 Registration Form

MAIN CONTACT: *required information

*Primary Phone: ______________________________________________________ ❏ Check here if new address/phone since last time registered.

*Last Name ____________________________________ *First Name _______________________________________ DOB: / / Sex: M/F

*Address: ______________________________________________________________________________________________________________

*City/State/Zip__________________________________________________________________________________________________________

*Secondary Phone _______________________________________________ * Email Address: ________________________________________

EMERGENCY CONTACT: (other than parent or adult participant)First Name __________________________________ Last Name_____________________________________ Phone_______________________

PARTICIPANTS:________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Rec Fund: $___________ Sr. Ctr. Mem: $___________ Multi-Course Discount: $___________$5______ $10______ $20______ Contribution to Recreation Fund: $_______

Total: $_______

Special Needs: Participants with special needs should contact our office three weeks prior to activity.

Release, Waiver, Assumption of Risk and Consent

Participation in the program may be a hazardous activity. Participant should not participate in the program unless participant is in good phys-ical shape and is medically able. Participant (or parent or guardian on behalf of a minor child participant) assumes all risks associated with participation in this program, including but not limited to, those generally associated with this type of program, the hazards of traveling on public roads, of accidents, of illness, and of the forces of nature. In consideration of the right to participate in the program and in further con-sideration of the arrangement made for the participant by the Mayor and Council of Rockville through its Department of Recreation and Parks for food, travel, and recreation, the participant, his or her heirs, and executors, or a parent or guardian on behalf of a minor child participant, agrees to release and indemnify the Mayor and Council of the City of Rockville and all of its agents, officers and employees, from any and all claims for injuries or loss of any person or property which may arise out of or result from participation in the program. The participant (or the parent or guardian on behalf of a minor child participant) grants permission for a doctor or emergency medical technician to administer emergency treatment of the participant and consents to the City’s use of photographs taken or videotapes made of the program that include the participant. Neither the instructor nor any of the staff are responsible for participants prior to or after the scheduled program.

*Signature of Participant/Guardian ____________________________________________________________________________________________________________

Main Line: 240-314-8620 • www.rockvillemd.gov/recreation • Fax: 240-314-8659

✎

Name (Last, First)SexM/F

BirthdateM/D/Y

Activity/Class Name

Course # School Attending Fee

PAYMENT

Amount Paid $_________________________ Cash ❏ Check #_______________________

❏ ❏ _______________________________________Exp. Date_____/____

Signature (name on card)________________________________________________________

OFFICE USE ONLY:

Check_____ Cash_____ Charge _____

Other_________________

Processed by:

Date Processed:

Total Paid: $

Sch. Yr.’15-’16Grade

Page 77

EARLY BIRD SPECIAL!

FORMS DUE by OCTOBER 30, 2015!

Ski Club Members For the 2015-16 Season you will PURCHASE YOUR NIGHT CLUB CARD ONLINE!

TO PURCHASE YOUR CARD, You Will Need To Log On To Your Unique Site:

A. Go to the following website:

https://sales.skiliberty.com/webwaresales/grplogin2.aspx

B. Enter the following information in the Club Login Box in the center of the screen

C. Select: Login.

Under ROCKVILLE HIGH SCHOOL:

Select See Available Items

Club Name: rockville

Password: member

A new page will open on your computer which lists the options for purchase.

You will choose the first option : NIGHT CLUB CARDS

When you have finished making your order copy and sign the release agreement. (this is also attached to your packet) Turn this form in to Mr. Rea.

If you need assistance please call 717-642-8282 ext. 3305 or email groups@skiliberty.com

3 GREAT MOUNTAINS * 3 TIMES THE FUN

2015-2016 LIBERTY/ROUNDTOP/WHITETAIL RESORTS 3-AREA NIGHT CLUB CARD RELEASE AGREEMENT COMPLETE FORM ENTIRELY AFTER ONLINE PURCHASE HAS BEEN COMPLETED. PLEASE PRINT. ONCE SUBMITTED, ANY CHANGE IS SUBJECT TO A $25 FEE.

NAME OF PASSHOLDER: _____________________________________________ NCC CLUB NAME: ____________________________

DATE OF BIRTH: __________________ PHONE #: _____________________________ EMAIL: _________________________________

PROGRAM LIABILITY RELEASE AGREEMENT

1. I agree on behalf of myself and/or the minor user I am representing to accept for use, AS IS all equipment to be provided, for

the duration of this program and accept full financial responsibility for the care of the equipment while it is in the user's

possession. I will be responsible for replacement at full value, for any equipment not returned by the agreed date and time.

2. I understand that breakage insurance applies to equipment breakage only, not lost, misplaced, or stolen equipment.

3. I or the minor I am representing will not use any equipment provided until instruction has been received and its use and

function are fully understood.

4. I will make no misrepresentations concerning my or the minor's height, weight, age or skier/boarder type.

5. I agree that at each session I or an authorized designee will verify that the visual indicator settings recorded on the rental form

agree with the numbers appearing in the visual indicator windows of the equipment listed on the form.

6. I understand that a ski-binding-boot system cannot guarantee the user's safety. In downhill skiing, the ski-binding-boot

system will not release at all times or under all circumstances where release may prevent injury or death, nor is it possible to

predict every situation in which it will release and therefore, provides no guarantee of safety. In snowboarding, skiboarding,

snowshoeing and other sports utilizing equipment with non-releasable bindings, the binding system will not ordinarily release

during use; these bindings are not designed to release as a result of forces generated during normal operation.

7. I fully understand and agree that the sports of skiing, snowboarding, skiboarding, snowshoeing, cross-country skiing and

other sports, including the use of lifts (collectively "RECREATIONAL SNOW SPORTS") involve inherent and other risks

that could lead to permanent catastrophic injury or death, and that injuries are a common and ordinary occurrence of the

sport, therefore, I freely and voluntarily assume for myself and/or the minor I am representing all the risk involved in

RECREATIONAL SNOW SPORTS, or which relate in any way to the use of this equipment.

8. I AGREE NOT TO SUE, TO RELEASE, HOLD HARMLESS, INDEMNIFY and DEFEND Ski Liberty Operating Corp.,

Ski Roundtop Operating Corp. and Whitetail Mountain Operating Corp., their owners, agents and employees, as well as the

equipment manufacturers and distributors and their successors in interest (collectively "PROVIDERS"), from all liability for

injury, death, property loss or damage (past, present, or future), that in any way results from the use of facilities or

participation in recreational snow sports or is in any way related to the use of the equipment issued to the user, including

liability that results from the NEGLIGENCE OF PROVIDERS or any other cause.

9. I understand that a helmet designed for recreational snow sports use may help reduce the risk of some types of injuries. I

recognize that serious injury or death can result from both low-energy and high-energy impacts, even when a helmet is worn.

10. I agree on behalf of myself or the minor child I am representing to report all injuries to the Ski Patrol before leaving the area.

11. I agree that all disputes arising under this contract, either for the use of rental equipment as described on the rental form, or

for the use of the facilities, shall be litigated exclusively in the Court of Common Pleas of the County where the incident took

place or in the United States District Court for the Middle District of Pennsylvania.

12. This agreement is governed by the applicable laws of this state. If any part of this agreement is determined to be unenforce-

able, all other parts shall be given full force and effect.

I, THE UNDERSIGNED, HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE LIABILITY RELEASE AS WELL AS,

THE RESPONSIBILITY CODE, CODE OF CONDUCT, SKIER TYPE CLASSIFICATION AND OTHER INFORMATION

PROVIDED ONLINE . I UNDERSTAND THAT I AM SIGNING ON BEHALF OF MYSELF, THE MINOR CHILD I AM

REPRESENTING, AND OTHER PARENT/GUARDIAN, AGREEING TO BE LEGALLY BOUND HERETO. I FURTHER

AGREE THAT MY SIGNATURE WILL APPLY FOR THE DURATION OF THE PROGRAM AND SHOULD I RENEW MY

CARD ELECTRONICALLY OR OTHERWISE THAT MY SIGNATURE WILL CONTINUE TO BE BINDING.

SIGNATURE _________________________________________________________________ DATE ______________________ Parent/Guardian (Required for participants under the age of 18.)

SIGNATURE _________________________________________________________________ DATE ______________________

Participant lw15/16

Please fill out the boxes below ONLY if you are purchasing a Lift, Lesson & Rental Card:

HEIGHT___ FT._____IN. WEIGHT ___________ SHOE SIZE __________ STANCE (REGULAR/GOOFY) M/F

Note - this field MUST be completed. Skier/Boarder Type (check one) Type 1 Type 2 Type 3

PARENT PERMISSION FORM RHS SKI & SNOWBOARD CLUB

This notice is to acquaint you with the plans for this winters activities in the RHS

Ski & Snowboard Club. Sponsored by The City of Rockville Recreation & Parks Department the ski club is operated as a school and community partnership. To accomplish these goals we must also rely on the support and cooperation of each member and their parent / guardian. We welcome any constructive suggestions regarding the club.

If you have any questions please contact me at 301-517-5527 or e mail: Thomas_A_Rea@mcpsmd.org.

Club meetings are on Fridays in room 2027. During meetings students will have

the opportunity to meet alike peers, play ski related videos and watch ski movies. In addition the students will be able to purchase a Night Club Card (NCC) from Ski Liberty which will allow them unlimited evening skiing throughout the winter season. Our objective this year is to have 6 single day evening trips to local ski areas (Ski Liberty, Ski

Whitetail and Ski Roundtop). We will be skiing/snowboarding on Friday afternoons from approximately 3:30 to 10:00. On “ski trip Fridays” , club members will get out of class at 2:10pm, collect their

gear and board a chartered bus in the school parking lot. The students will have a storeroom available on “ski trip Friday” to store their gear during school hours. The bus leaves the RHS parking lot at 2:30pm. Lessons will be given at the mountain starting at 4:30 for all ability levels and are highly recommended. Adult (teacher & parent)

chaperones will either ski with the students or will be available at the rental/lesson /lodge area. We will return to the RHS parking lot at midnight. Our first trip will be the Third week of January and we will continue for the Next 5 consecutive Fridays. Please note that The City of Rockville Recreation & Parks Department maintains

the following basic rules which must be adhered to for the club to function smoothly. Your signature on this permission slip, and the receipt of this notice constitute acceptance of these rules.

City of Rockville/Rockville High Ski & Snowboard Club RULES

1. Club activities are for members only. We will form an advisory committee so that

students can assist in running the club. Meetings will be open to all members.

2. Smoking, drinking, drugs, vandalism, other misconduct, etc. will lead to appropriate

disciplinary action, including immediate and permanent expulsion from the club as well

as MCPS disciplinary measures. There will be NO REFUNDS. Parents will be expected

to pick up a student immediately from an activity, including ones outside the area.

3. Violating rules at the resorts may lead to having your NCC revoked or suspended. There

will be NO REFUNDS for such infractions.

4. In case of Emergency at the resort, parents will be expected to pick up their child at the

resort or arrange for transportation home from the resort. A chaperone will stay with your child.

5. Parents are expected to pick students up promptly from the parking lot upon return from

the ski trips. Failure to do so will result in loss of privileges. Under no circumstances will

students be driven home by chaperones.

6. Students will be prevented from attending Friday trips for behavioral infractions and/or

financial obligations at RHS.

7. Since it is necessary to make financial commitments in advance, all monies collected prior to a trip are nonrefundable.

8. We insist that every student ride the bus to and from the resort for every trip. We will

always have adult chaperones on the bus.

City of Rockville Department of Recreation and Parks

Parent Permission Form

Name: _________________________ Age/Grade _______ Activity: RHS Ski & Snowboard Club

Address: _______________________________________________________ Zip:_______________

Phone(H): __________________________ Phone (W): _____________________________

Emergency Name________________________________ Emergency Phone: __________________ The participant assumes all risks associated with participation in the program; the City of Rockville and RHS Ski & Snowboard Club assumes no liability for injury or damages arising from participation in the program. Due to the strenuous nature of some act ivities, the

City encourages each participant to consult his or her physician concerning fitness to participate in the program. The participant consents to emergency treatment. The participant also consents to the City’s use of any photographs taken or video tapes made of the

program. If the participant is a minor, the parent or guardian approves his or her participation in the program.

Parent Signature: ________________________________ Date _________

CITY OF ROCKVILLE

PARTICIPANT INFORMATION FORM

PROGRAM SESSION _____________________

CONFIDENTIAL INFORMATION:

Child’s Name: ________________________________________________________________

Child’s Nickname: _____________________________________________________________

Sex: _______ Birth date: _____________________ Age: _______

Child’s Primary Language: ___________________School attending: _____________________

Teacher’s Name: ___________________________ School Enrollment Date ________________

Weekdays and Approximate Times Child will Attend Program: __________________________

Child’s Home Address __________________________________________________________

Child’s Home Phone number_____________________________________________________

Parent/Guardian 1 Name ______________________________ Home Telephone ___________________

Parent/Guardian 1 Employer _____________________________________________________________

Name Address

Parent Guardian 1 Home Address (if different from above) _____________________________________

Work Telephone _____________________________Cell Phone _________________________

Parent Guardian 2 Name ______________________________ Home Telephone _____________________

Parent Guardian 2 Employer_______________________________________________________________

Name Address

Parent Guardian 2 Home Address (if different from above)

_______________________________________

Work Telephone ____________________________ Cell Phone ___________________________

DEPARTURE PROCEDURES:

I understand that no child can be released to anyone except custodial parents without specific written

permission. I agree to give the center a list of all adult persons, sibling’s 16 years and up that are authorized

to pick up my child and the circumstances under which my child can be released to these persons. In

addition, I agree to provide the center with copies of legal documents prohibiting an individual

authorization to pick up my child. Individuals picking up children will be required to show a picture ID

card. A child will not be allowed to walk home from the program on his or her own. If there are any

changes in the information, you must submit the change in writing.

Please check appropriate box: Authorize Child to be released to:

Parent/Guardian 1 Yes No Parent Guardian 2 Yes No Legal Guardian Yes No

IN ADDITION TO PARENTS, MY CHILD MAY BE CONTACTED IN CASE OF AN EMERGENCY

AND RELEASED TO THE FOLLOWING PEOPLE:

Name Relationship Phone

1. __________________________________________________________________________________

2. __________________________________________________________________________________

3. __________________________________________________________________________________

Legal Custody Restraints - Persons who MAY NOT pick up my child Legal papers must be on file.

Name Relationship

1. __________________________________________________________________________________

2. __________________________________________________________________________________

MEDICAL INFORMATION:

Parent/ Guardian Insurance Co.: _________________________ Policy No.: ______________________

Name of Family Physician: _____________________________ Phone: __________________________

Allergies to food/medication or other allergies (Please specify): ________________________________

____________________________________________________________________________________

Is the child under physician’s care for health needs on a continuing basis? ____ YES ____ NO

Is the child on medication or treatment on a continuing basis? ____ YES ____ NO

Medical Condition(s): _________________________________________________________________

___________________________________________________________________________________

Medications currently being taken by your child: ____________________________________________

___________________________________________________________________________________

Date of Child’s last Tetanus shot: ________________________________________________________

EMERGENCY MEDICAL INSTRUCTIONS AS APPROPRIATE:

Signs/Symptoms to look for: ____________________________________________________________

____________________________________________________________________________________

If signs/symptoms appear, do these: _______________________________________________________

____________________________________________________________________________________

To prevent incidents: __________________________________________________________________

____________________________________________________________________________________ Other special medical procedures that may be needed: ________________________________________

____________________________________________________________________________________

DISCIPLINE POLICY:

Child and staff are entitled to a pleasant and harmonious environment where children can unwind and

regenerate. Children will be given the opportunity to select various activities for themselves within an

untroubled atmosphere of cooperation from children in the group.

Staff members will familiarize and involve children with the standards of conduct expected of them during

the Program.

Staff members will use various positive discipline techniques to maintain a program that is safe,

affirmative, and enjoyable to all.

If a child repeatedly displays disruptive behavior, the parent will be notified and a conference will be

arranged to discuss the concerns. Parents will be expected to assist staff in resolving problems and

promoting the child’s positive, cooperative behavior.

Following a parent conference (or if parent fails to attend a conference), or if a child’s behavior is

chronically disruptive, or harmful to others and/or property, or requires constant, unwarranted attention

from staff members, Staff reserves the right to suspend or discharge a child from the Program.

ADMINISTRATIVE POLICIES:

I understand that all required forms and full payment must be completed and on file before my child can

attend the program. After the initial session, I understand my child will not be automatically registered in

any sessions thereafter, or be able to attend any additional sessions without full payment.

I understand that if my child is having problems adjusting to the program, I will be notified and a

conference will be arranged between me and staff.

I understand that I may be asked to withdraw my child if his/her behavior patterns threaten his/her own

health and safety or those of other children, or consistently disrupts the program. A refund will not be

issued when your child is asked to leave the program.

I understand that it is my responsibility to keep all emergency information updated with work, home, and

cell telephone numbers and any other pertinent information.

I understand that my child cannot attend the program if he/she has any illness that threatens the health of

other children. A doctor’s note may be required for re-admittance to the program.

I understand that no medication will be administered without completion of the Medication Order Form for

medications such as inhaler or epipen.

I agree to pay a late fee of $10.00 for each 15 minutes (or portion of 15 minutes) per child whenever my

child is cared for after Program hours regardless of the reason for being late. I understand that I will be

asked to pay overtime fees at the time I pick-up my child. I also understand that I may be asked to remove

my child from the program if tardiness is habitual.

I agree to adhere to the Program registration policies and give my child permission to participate fully in

this program.

I agree to sign my child out of the program everyday.

PHOTOGRAPHIC PERMISSION:

Please check the appropriate box: [] I do [] I do not

Give permission to have my child appear in future program brochures, newsletters or any other media

coverage approved by The City of Rockville.

MOVIE PARTICIPATION: In accordance with City of Rockville Recreation and Parks Policies we are requesting permission for your

child to watch G and/or PG movies during the Program

I grant my child _______________________________________________ permission to participate in

Program movie time.

Parent/Guardian Signature: ___________________________________________ Date: ______________

SIGNATURE:

The Program staff has my permission, in an emergency when I or my physician cannot be contacted, to

take my child to the emergency room of the nearest hospital, and the hospital and its medical staff have my

authorization to provide treatment, which a physician deems necessary for the well being of my child.

I understand my responsibilities for picking up my child and my responsibilities to advise other family

members designated to pick up my child.

I understand the Program Discipline Policy and that I have discussed the policy with my child

I have reviewed all of the information contained in this registration packet; all of the information I have

provided is correct; I understand all my responsibilities for enrolling my child in the Program; and I agree

to abide by all of the rules as stated in this document.

Parent/Guardian Signature: ___________________________________________ Date: ______________

RELEASE, WAIVER, ASSUMPTION OF RISK AND CONSENT

Participation in the program may be hazardous activity. Participant should not participate in the program

unless participant is in good physical shape and medically able. Participant (or parent or guardian on behalf

of a minor child participant) assumes all risks associated with participation in this program, including but

not limited to, those generally associated with this type of program, the hazards of traveling on public

roads, of accidents, of illness, and of the forces of nature. In consideration of the right to participate in the

program and in further consideration of the arrangement made for the participant by the Mayor and Council

of Rockville through its Department of Recreation and Parks for food, travel, and recreation, the

participant, his or her heirs, and executors, or a parent or guardian on behalf of a minor child participant,

agrees to release and indemnify the Mayor and Council of the City of Rockville and all of its agents,

officers and employees, from any and all claims for injuries or loss of any person of property which may

arise out of or result from participation in the program. The participant (or the parent or guardian on behalf

of a minor child participant) grants permission for a doctor or emergency medical technician to administer

emergency treatment of the participant and consents to the City’s use of photographs taken or videotapes

made of the program that include the participant. Neither the instructor nor any of the staff are responsible

for participants prior to or after the scheduled program.

Parent/Guardian Signature: ___________________________________________ Date: ______________

A copy of this document is provided for your records.