Massachusetts Ski & Snowboard Club, LLC
12 Royal Crest Drive
Douglas, MA  01516

Member Name: _____________________________________________________________________
Age: _____________________________________________________________________
Gender: _____________________________________________________________________
Home Phone: _____________________________________________________________________
Cell Phone: _____________________________________________________________________
Email Address: _____________________________________________________________________
Home Address: _____________________________________________________________________
City, State & Zip: _____________________________________________________________________
Bus Stop (if known): _____________________________________________________________________
Years in Club? _____________________________________________________________________
How did you hear about Club? _____________________________________________________________________
Parent/Guardian #1 Parent/Guardian #2
Name:   Name:  
Cell Phone:   Cell Phone:  
Home Phone:   Home Phone:  
Work Phone:   Work Phone:  
Email:   Email:  

Medical Release: Due to the nature of skiing/snowboarding it is understood that I release the Massachusetts Ski Club, Inc., its employees, agents and servants from all liability of any sort and that they be held harmless and indemnified for any accident or injuries sustained by my child while participating in your program. Furthermore, I authorize the Massachusetts Ski Club, Inc. to carry out any medical treatment for my child, including but not limited to X-rays, which may be recommended by a hospital or doctor. My child and I agree to abide by the rules and regulations of the Massachusetts Ski Club, Inc. as printed in the Parent�s Guide.