Tomahawk Ski Trip Registration | Sauganash Study Center

Personal Information

Name*

First Last

Phone Number of Parent (for emergencies)*

Date of Birth*

Parent Email Address*

Miscellaneous

Medical Insurance Company*

Medical Insurance Group Number*

Medical Insurance Policy Number*

Medical Insurance Phone Number*

Electronic Signature for Medical & Photo Release*

As the parent or legal guardian of the participant identified on this registration, I hereby delegate authority to the Directors of the "Tomahawk Ski Trip" to arrange whatever medical treatment they deem necessary for him during the activity. Also, I hereby authorize and consent to the use and reproduction by Sauganash staff or an authorized agent or assignee of any and all photographs taken of my son for the purpose of promoting Sauganash programs, without any compensation to me. All film, together with any prints, shall constitute property of Sauganash, solely and completely.

Comments

Please include any medical or dietary needs.