Hopewell Township Parks & Recreation Department… TEEN Ski/Snowboard Trip to….. Tuesday Feb. 17, 2015 The Hopewell Township Parks and Recreation Department travels to Shawnee Mountain for a skiing and snowboarding adventure exclusively for students in grades 6 through 12. Features at Shawnee include: § § § 700’ Vertical 23 slopes & trails, 2 terrain parks 10 lifts including 1 high speed detachable quad, 1 quad & 4 double chair lifts TIME: Arrive at Timberlane Middle School by 7:45am. Bus departs promptly at 8:00am. We will return to the TMS parking lot at approximately 6:00 pm (Please be sure to have a ride waiting) LOCATION: Shawnee Mountain, East Stroudsburg, PA COST: Packages available as listed below and includes round-trip motor coach transportation. There are a variety of ski packages available including a lift ticket only, lift & rentals, or “Best Value” Ski/Snowboard Packages. Please read carefully and decide which option best fits your needs. A. Full Access Lift Ticket Only: $70 For experienced participants who are bringing their own skis or snowboards. B. Full Access Lift Ticket with Ski or Snowboard Rental $92 For experienced participants who need to rent skis or a snowboard. C. “Best Value” Ski or Snowboard Package: $98 This package includes an all mountain lift ticket, rental equipment & 1 ½ hour group lesson. D. Lunch Voucher: $8.50 (Includes soda, fries & choice of burger, salad or chicken sandwich; saves $) E. Helmet: $9.00 (This is optional but recommended; save $ and avoid lines by pre-paying for helmet) You will be registered once we have received: · · · Your registration/waiver form. Your check made payable to the “Hopewell Township Parks & Recreation Department” (HTPRD) We will then email you instructions on how to sign-up for your ski/snowboard rental on-line. Parents-- We need a few chaperones! Please let us know if you are available to help. Registration forms are available at www.hopewelltwp.org or call the Recreation Department at 737-3753. Deadline to register is February 9th, 2015 TEEN SKI TRIP Tuesday, Feb. 17th, 2015 - Registration Form HOPEWELL TOWNSHIP PARKS AND RECREATION DEPARTMENT DESTINATION – Shawnee Mountain Participant’s Name: Age: and Cell Phone: Date of Birth: Current Grade : Address: Street Town Home Phone: Email Address: Parent Name: Cell Phone: Zip Code Please provide an emergency contact and their phone number. Name/Relationship: Cell Phone: PLEASE CHECK THE PACKAGE THAT APPLIES TO YOU : (See program flier for details) $70 Full Access Lift Ticket Only $92 Full Access Lift Ticket & Ski or Snowboard Rental (circle one) $98 “Best Value” Ski or Snowboard Package (includes lift ticket, rentals & group lesson) $ 8.50 Lunch Voucher (optional, includes soda, fries, & choice of burger, salad, or chicken sandwich) $ 9.00 Helmet Rental (optional; pre-pay to save $ and avoid lines) TOTAL Amt. Due Deadline to register is February 9, 2015 Make checks payable and send to: Phone # (609) 737-3753 Hopewell Township Parks & Recreation Department (HTPRD) 201 Washington Crossing-Pennington Road Titusville, NJ 08560 Hold Harmless Agreement: I recognize that skiing and snowboarding can be dangerous activities and understand every possible precaution will be exercised to assure the safety and welfare of my child. Participants assume all reasonable risks which may exist by virtue of participating in these activities and hereby indemnify, hold harmless, waive and release any and all rights and claims for damages against the Township of Hopewell, its agents, servants and employees, the Hopewell Township Parks and Recreation Department, its agents, servants and employees, and other such individuals who may be involved in the planning and implementation of the program, for claims by participants, heirs, executors, administrators, or any other third parties for injuries that may arise from participation in this program, or acts of negligence or gross negligence arising out of this agreement. ESignature of Parent: Date: Medical Treatment Release: I hereby authorize emergency medical care for my child/children during attendance on this trip. If, in the judgment of the staff, treatment is required for any injury or illness, I also hereby authorize the administering of anesthetics and recourse to other procedures deemed necessary by attending physician. I understand that whenever possible I will be notified prior to medical treatment of my child/children, or at the earliest possible time should prior notice prove impossible. I further understand that I am financially responsible for any medical expenses or emergency transportation incurred on my child/children behalf. My child has the following medical condition you should know about: Doctor's Name: ESignature of Parent: Phone: Date: