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.

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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)
January 22nd, 2016 (Roundtop)
January 29th, 2016 (Whitetail)
February 5th, 2016 (Roundtop)
February 12th , 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
Page 77
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:
________________________________________________________________________________________________________________________
Sex
M/F
Sch.Yr.
’15-’16 Fee
Grade
________________________________________________________________________________________________________________________
Name (Last, First)
Birthdate
M/D/Y
Activity/
Class Name
Course #
School Attending
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
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 physical 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 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 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✎
____________________________________________________________________________________________________________
PAYMENT
Amount Paid $_________________________ Cash ❏ Check #_______________________
❏
❏
_______________________________________Exp. Date_____/____
Signature (name on card)________________________________________________________
OFFICE USE ONLY:
Check_____ Cash_____ Charge _____
Other_________________
Processed by:
Date Processed:
Total Paid: $
Main Line: 240-314-8620 • www.rockvillemd.gov/recreation • Fax: 240-314-8659
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
Club Name: rockville
Password: member
C. Select: Login.
 Under ROCKVILLE HIGH SCHOOL:

Select See Available Items
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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 [email protected]
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: _________________________________
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)
Note - this field MUST be completed. Skier/Boarder Type (check one)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Type 1
Type 2
M/F
Type 3
PROGRAM LIABILITY RELEASE AGREEMENT
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.
I understand that breakage insurance applies to equipment breakage only, not lost, misplaced, or stolen equipment.
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.
I will make no misrepresentations concerning my or the minor's height, weight, age or skier/boarder type.
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.
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.
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.
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.
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.
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.
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.
This agreement is governed by the applicable laws of this state. If any part of this agreement is determined to be unenforceable, 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
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:
[email protected].
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?
Is the child on medication or treatment on a continuing basis?
____ YES
____ YES
____ NO
____ 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.