2009 Registration Form

Registration Form

PVSC Racing Development Program

Session #1: January 3,10,17, 24 2009

Session #2: January 31, February 6 ,13, 27

Participant:__________________________ DOB:_________ Gender: M F

Parent/Guardian:____________________________________________________

Address:____________________________________________________________

E-mail address of parent:_______________________________________________

Home phone:_________________ Cell phone:____________________

Second emergency contact (name, phone, address):

___________________________________________________________________

Please circle the enrollment fee(s) that apply to you: (You must be a PVSC member to race --- non-members can join PVSC below)

PVSC member? (circle one)   YES        NO      (please enclose $25 for membership in addition to program registration fee below)

Racing program session registration fee:

$85 /session (for those without season pass to New Hermon Mountain)

$25/session (for those with season pass to New Hermon Mountain)

Make checks payable to: Penobscot Valley Ski Club

Mail registration form and check to: Cindy Mitchell

85 Summer St.

Hampden, ME 04444

Alpine skiing and ski racing are inherently dangerous sports. I acknowledge those risks and grant permission for my child to participate:

___________________________________________________________________

Signature of parent or guardian                                                                 Date

***Registration is on a first-come first-serve basis - sign up NOW!

***Skiers who are not paid in full will not be allowed to participate

***All skiers must wear a helmet to participate