Ski and Snowboard

Lesson Registration

Registration: Please submit this form once per student

First:
Last:
Address:
City:
State:
Zip:
Home Phone:
Cell:
Email Address:

Parent/Guardian:
Alt. Emergency Contact:
Emergency Phone:
Physician Name:
Physician Phone:
Hospital Preference:
Medication (if taken):
Alergies:
Insurance Company:
Policy Number:

School:
Grade:
Age:
Gender:

Transportation:
I'd like to ride with
Package:
Ski Ability
Snowboard Ability

How did you find us:
Comments:
*All fields are required