Name *(Must be same as in your passport or the official ID being used (e.g., driver's lic.): _______________________________________________ Sex: M___ F____
Address:
_____________________________________________________________
Date of Birth: _______________Phone:_____________________________
E-Mail Address: _________________________________________
EMERGENCY CONTACT INFORMATION:
Name: __________________________ Phone: _________________________
Address:_____________________________________________________Relationship: ______________
Preferred Lodging: __________________________
Single Room (one person to a room – surcharge applies) _______________________
Double Occupancy (two to a room)___ Roommate (name): ______________________
(NOTE: each trip participant must submit a trip sign up form)
Other (i.e., condo)_______________________________________________________
Skiing Ability: Beginner ___ Intermediate ___ Advanced ___
Interests: Cross-Country ___ Non-Skier ___
Options: Lessons ___ Rentals ___ Sight Seeing ___ Other ____
Send the Sign Up Form, with the signed waiver form, directly to the trip leader. Address is provided on the Trip information flyer. The deposit check, payable to Capital Golden Skiers, must be mailed to the trip leader by the specified deadline to secure your reservation.
Rev 9-28-10 * Conforms with Transportation Security Administration (TSA) requirements
Release and Waiver of Liability
The Capital Golden Skiers herein referred to as the Club is a year-round social and sports organization providing a variety of activities for its members. These activities include, among others, skiing, hiking, biking, canoeing, kayaking, rafting and dancing which present inherent dangers that cannot be eliminated even by exercise of reasonable care and are to varying degrees, hazardous. I understand that the Club is a voluntary association run by volunteers who are not professionally trained in conducting sports, cultural, and other activities. By participating, I agree that I am solely responsible for my personal safety and conduct. I agree to indemnify and hold harmless the Club, its officers and board members, trip leaders, and agents or contractors from any loss, cost , or expenses incurred by or attributable in any way to any trip or activity. I understand that the Club acts only as a coordinator and accepts no responsibility for any person or entity rendering any services or accommodations being offered on any trip. The Club accepts no responsibility in whole or in part for loss and damage of property or injury, including death, to any person; changes in cost; delays; and substitutions in services or accommodations. The undersigned recognizes that the Commonwealth of Virginia, State ofMaryland and District of Columbia have the most significant relationship with the parties to this agreement rather than the destination state, province or country. This release shall be binding upon the assignees, subrogates, distributes, heirs, next of kin, executors, and administrators of the undersigned and may be pled by the Club as complete bar and defense against any claim, demand, action or cause of action by or on behalf of the undersigned.
I have read and understand this Release and Waiver of Liability Agreement. I certify that the primary applicant is 50 years of age or older. Note: The spouse or companion need not be 50 years of age or older.
Signature___________________________Print Name________________________Date____________
