CBNT Registration - Crested Butte Nordic - Nordic Ski Capital of Colorado

Athlete Information

Athlete's First Name

Athlete's Last Name

Athlete's Date of Birth

Athlete's Age as of December 31, 2019

Athlete's Gender

MaleFemale

Any Allergies, Health Concerns, or Medications?

Which Program?

Which days? (select all that apply)

ThursdayFriday

Which days? (select all that apply)

MondayWednesday

Would you like to add on the biathlon program?

Yes, Wednesday Biathlon (Dec. 11 - Mar. 11) $120Biathlon is available to middle school and up only.

Athlete 1 Subtotal

Would You Like to Register Another Athlete?

YesNo

Second Athlete Information

Athlete's First Name

Athlete's Last Name

Athlete's Date of Birth

Athlete's Age as of December 31, 2019

Athlete's Gender

MaleFemale

Any Allergies, Health Concerns, or Medications?

Which Program?

Which days? (select all that apply)

ThursdayFriday

Which days? (select all that apply)

MondayWednesday

Would you like to add on the biathlon program?

Yes, Wednesday Biathlon (Dec. 11 - Mar. 11) $120

Athlete 2 Subtotal

Would You Like to Register Another Athlete?

YesNo

Third Athlete Information

Athlete's First Name

Athlete's Last Name

Athlete's Date of Birth

Athlete's Age as of December 31, 2019

Athlete's Gender

MaleFemale

Any Allergies, Health Concerns, or Medications?

Which Program?

Which days? (select all that apply)

ThursdayFriday

Which days? (select all that apply)

MondayWednesday

Would you like to add on the biathlon program?

Yes, Wednesday Biathlon (Dec. 11 - Mar. 11) $120

Athlete 3 Subtotal

Medical Information

Physician Name

Physician Phone

Parent/Guardian 1 Information

First Name

Last Name

Best Phone between 3 & 6 pm:

Parent/Guardian 2 Information

First Name

Last Name

Best Phone between 3 & 6 pm:

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Mailing Address

Address Line 1

Address Line 2

City

State

Postal Code

Assumption of Risk and Release of Liability

I understand that participation in any skiing activity, including Nordic competition, Biathlon and Backcountry Skiing (the “Activity”) involves risk of serious injury, including permanent disability, death, and other losses, both to myself and my property. I understand that these injuries and losses might result not only from my actions, but the actions, inactions or negligence of others. I agree that I am responsible for my safety while participating in the Activity and that such responsibility includes participating only when I am both physically and psychologically prepared to participate safely, after fully familiarizing myself with the venue before the event, and while using equipment of a type and condition reasonably necessary to safely participate in the Activity. Aware of the risks and willing to assume them, I hereby waive, release, and hold harmless Crested Butte Nordic, Town of Crested Butte, all sponsors and each of those organization’s affiliates, subsidiaries, officers, directors, employees, agents, event organizers and sponsors, the land owners and home-owner associations, coordinating groups, doctors, officials, any individuals associated with the Activity, their representatives, successors and assigns, and will hold them harmless for any deaths or injuries suffered in connection with said Activity, including those which may be attributable to weather conditions. I intend for this waiver and release also to apply to any relatives, personal representatives, heirs, beneficiaries, next of kin or assigns who might pursue any legal action or claim on my behalf. In filling out this form, I also give permission for the use of my name and/or any record of my participation with the Activity for publicity and/or promotional purposes. With full knowledge and understanding of the RISK OF SEVERE INJURY AND DEATH involved in the Activities, I FREELY AND VOLUNTARILY ACCEPT AND FULLY ASSUME THE RISK THAT I MAY SUFFER TEMPORARY, PERMANENT OR EVEN FATAL INJURIES, even if I follow the instructions or advice of the Crested Butte Nordic Team.

We (Parent(s) and Athlete(s)) have read and agree to the Assumption of Risk and Release of Liability.

Media Release
I grant my irrevocable permission to the Crested Butte Nordic Council and its authorized agents to use and to own, without compensation, any photographs, video, motion pictures, recordings or any other record of my child's participation in this program to create derivative works therefrom, for any purpose, in any form, media or format.

Please check below if you DO NOT agree to the media release.

I DO NOT grant permission for use of photos of my child(ren).

Sign-in/out Procedures

The majority of the time, how will your child(ren) arrive to practice?

By BusWalking from schoolParent drop-offOther

Please Specify:

The majority of the time, how will your child(ren) depart practice?

WalkingBikingParent pick-upAnother child's parent pick-up

Please list the people allowed to pick up your child(ren) from practice:

Do you have any additional notes for the coaches?

How Will You Pay?

In-full Now by Credit CardIn 3 Installments (Installment 1 will be charged now, other payments are due Feb.1 and Mar. 1)I have a scholarship

Total Amount Due for Season:

Thanks! We will be in touch about your scholarship amount and charge you for your program at a later date.

Amount your card will be charged (First of 3 Installments):

Amount your card will be charged:

Charge:

Payment Information

Name on Card

Billing Email

Card Number

Code

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