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City__________________________ Zip_____________________
Home Phone_____________________________________________________________
Work Phone(s)___________________________________________________________
City__________________________ Zip_____________________
Have you completed and signed the attached Medical Release? __________________
Statement of Risk: I, __________________________________ understand that alpine skiing carries significant risks
of personal injury. I know there are natural and manmade obstacles or hazards, surface and environmental conditions
and risks which in combination with a racer’s actions could cause severe or occasionally fatal injuries. In participating
in the Juneau Ski Club programs and skiing at Eaglecrest, such dangers are recognized and accepted whether they are
marked or unmarked. I hereby release and hold harmless Eaglecrest Ski Area and it’s employees, the Juneau Ski Club,
it’s coaches, race officials, USSA, USSA Alaska Division and any person connected with the above program during
participation in any Juneau Ski Club activity, including but not limited to training, racing, work parties, social events,
use of Eaglecrest Ski Area and Juneau Ski Club facilities or equipment, team travel, or any social events associated
with the Juneau Ski Club programs.
Residence Address
Mailing Address
Phone Numbers
Personal Physician
Medical History
Policy Number
Enrollment Form, Medical Release & Payment Due on or Before January 9, 2011.
This activity is partially funded by the Citizens of the City and Borough of Juneau.