PA Ski Club - Jay Peak Waitlist Registration

Jay Peak Trip Wait list Registration

Thank you for your interest in joining PA Ski Club's Jay Peak Trip. Currently, the trip is completely full and we have instituted a wait list to for students who wish to wait for a spot to open up in the trip. The wait list is first come, first serve and you will be added in order of when the registration form is submitted. Being on the wait list does not guarantee you a spot in the program. If a currently registered student drops from the program, then we will contact the next person in line on the wait list.

PA Ski Club Jay Peak Trip

Parental Consent & Release Form

I am the parent/guardian of a minor, who desires to participate in the following school activity: PA Ski Club's Jay Peak Trip. Date of Activity: 2/7/25 - 2/9/25.

I acknowledge that I have been fully informed as to the nature of the activity and the provisions for my child’s involvement and consent to my child’s participation in the above-described school activity. I understand that due to the nature of the activity my child will be in close proximity with students, staff, and other individuals, and that this activity may include an enhanced risk of illness, including the possibility of my child contracting COVID-19.

In consideration of the permission granted to my child to participate in the above-described activity by Pinkerton Academy, I release and hold harmless Pinkerton Academy, its agents, employees, and officers from any and all actions or causes of action of any nature for personal injury or property damage of any kind arising in any way from my child’s participation in the above-described school activity. I further acknowledge that this release is binding upon my heirs, successors and assigns: that I have read the foregoing and understand its significance and that I have executed this document voluntarily.

Student's First Name*

Student's Last Name*

Student ID #*

Student's Grade*

Date*

Email*

Will your student be purchasing a Water Park ticket?*YesNo

Tickets to the water park cost an additional $40. By checking "Yes" and signing below, I acknowledge that I have been fully informed as to the nature of the activity and the provisions for my child’s involvement and consent to my child’s participation in the Jay Peak Water Park activity. I understand that due to the nature of the activity my child will be in close proximity with students, staff, and other individuals, and that this activity may include an enhanced risk of illness, including the possibility of my child contracting COVID-19. In consideration of the permission granted to my child to participate in the above-described activity by Pinkerton Academy, I release and hold harmless Pinkerton Academy, its agents, employees, and officers from any and all actions or causes of action of any nature for personal injury or property damage of any kind arising in any way from my child’s participation in the above-described school activity. I further acknowledge that this release is binding upon my heirs, successors and assigns: that I have read the foregoing and understand its significance and that I have executed this document voluntarily.

Parent/Guardian Signature*

Health Information Sheet

This form will be provided to the doctor or medical personnel to whom your child is taken in the event of a medical emergency while on a school-sponsored field trip. Please complete ALL sections as accurately as possible and return to your field trip organizer.

Is this an Overnight Trip?*YesNo

Student First Name*

Student Last Name*

Home Address*

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Telephone Number* - -

Date of Birth*

Emergency Contact #1*

Emergency Contact #1 First Name*

Emergency Contact #1 Last Name*

Emergency Contact #1 Home Phone* - -

Emergency Contact #1 Cell Phone* - -

Emergency Contact #1 Work Phone* - -

Emergency Contact #1 Email*

Emergency Contact #2*

Optional

Emergency Contact #2 First Name*

Emergency Contact #2 Last Name*

Emergency Contact #2 Home Phone* - -

Emergency Contact #2 Cell Phone* - -

Emergency Contact #2 Work Phone* - -

Emergency Contact #2 Email*

Emergency Contact #3*

Optional

Emergency Contact #3 First Name*

Emergency Contact #3 Last Name*

Emergency Contact #3 Phone* - -

Primary Care Physician*

Family Doctor Telephone* - -

Food or drug allergies*

If none, please write "No allergies."

Other allergies*

If none, please write "No allergies."

Date of last Tetanus shot*

Present medications*

If none, please write "No medications."

Chronic Medical problems*

If none, please write "None."

Other concerns for awareness*

If none, please write "None."

Parental/Guardian Authorization:

In case of medical emergency, in the event I cannot be reached, I authorize Pinkerton Academy, its agents, employees, and other officers to procure and consent to any medical examination, diagnostic process or course of treatment, including hospital care, to be rendered to my child by or under the supervision of any duly licensed doctor, dentist, or surgeon.

Parent/Guardian*

Today's Date*

Health Insurance Company*

Policy Number*

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Clubs & Activities

Jay Peak Trip Wait list Registration

PA Ski Club Jay Peak Trip

Parental Consent & Release Form

Health Information Sheet

Parental/Guardian Authorization: