Forms Forms Forms 2024 Health & Policy Form Scholarship Inquiry Form Quick LinksPolicies & FAQs→ 2024 Health & Policy Form Open Form 2024 Registration Form Parent/Legal Guardian's Name * First Name Last Name Home Phone Country (###) ### #### Work Phone Country (###) ### #### Cell Phone * Country (###) ### #### Alternative Phone Country (###) ### #### Email * Child (rider) Information Child's Name * First Name Last Name In Which Program Will Your Child Participate? * After-School/Saturday Progression Summer - Half Day Camp Summer - Day Trip Summer - Weekly Day Camp Summer - Overnight Camp Private Lesson Child's Age at Start of Camp * Child's T-shirt Size * Youth XS Youth S Youth M Youth L Youth XL Adult XS Adult S Adult M Adult L Adult XL Adult XXL What is Your Child’s Swim Level? * Non-swimmer-Unable to swim, float, or be past knee level water Beginner- Shows comfort in the water and able to play in water that is between waist & chest depth. Intermediate- Can swim with comfort in water that is over his/her head, float and tread water for at least 1 minute Advanced- Can swim in water over his/her head, float and tread water for up to 5 minutes Non-swimmer Beginner Intermediate Advanced Medical Information Will your child need to take any medications during camp hours? * NOTE: The child Physician’s note must be accompanied by any medications to be taken at camp. Yes No If Yes, please indicate the type of medication(s), its purpose, and how it is to be administered while at camp. Does your rider have any of the following conditions? If so, please share additional information in the space below. * Frequent Ear Infections Frequent Colds or Fevers Food Allergies or Sensitivities Other Allergies Bleeding Disorders Reactions to Insect Stings Reaction to Poison Ivy Autism Hearing Impairment Visual Impairment Sensitivity to Sun Asthma or other breathing difficulties Other None Please share additional information. Does your rider carry an epinephrine kit or an inhaler? * NOTE: Your child must be capable of self-administration of the epi-pen and/or inhaler. Yes No If yes, does s/he know how to use? if yes, where will the kit be during camp? Emergency Contact and Pick-up Authorization In case we cannot reach the Parent/Guardian listed above, please provide an emergency contact. * Emergency Contact Relation * Emergency Contact Phone * Country (###) ### #### Alternative Emergency Contact and Phone Number Pick-up Authorization * Please list all adults (including parents) authorized to pick up your child: Medical Consent I authorize SMBA to offer my rider sunscreen if needed. * Yes No I authorize SMBA to offer bug repellant as needed. * Yes No I authorize SMBA to administer over-the-counter medications, such as Advil or Benadryl, if needed. * Yes No Stowe Mountain Bike Academy Release Statement As the parent/legal guardian of * Enter your child's (rider) name I Consent * Enter Parent/Legal Guardian's Name By checking this box you consent to this Release Statement: * I am fully aware that there are risks of physical injury in participating in mountain biking, sports, and recreational activities and hereby give my consent for the named applicant to participate in the program(s) offered by Stowe Youth Cycling, LLC dba Stowe Mountain Bike Academy or Vermont Mountain Bike Academy, LLC programs. Yes By checking this box you consent to this Release Statement: * I acknowledge that without a completed waiver my child will not be permitted to participate in Stowe Youth Cycling, LLC dba Stowe Mountain Bike Academy or Vermont Mountain Bike Academy, LLC programs. To complete this waiver, please select the black "Sign our waiver" button at the bottom right side of this website. Yes By checking this box you consent to this Release Statement: * I certify that my child/participant is in excellent health and that there are no limitations to his/her participation except as stated above in this form. Furthermore, in the event of an emergency, accident, injury, or illness and if reasonable effort to contact me has failed, I hereby give the designated emergency contact permission to act as my childs(rens) temporary guardian. In the event of an accident, injury, or illness and if reasonable effort to contact me has failed, I hereby give attending physicians or authorized medical personnel consent and permission to provide my child/participant with any necessary medical treatment, including x-rays and medication. Yes By checking this box I consent to this Release Statement: * I understand that Stowe Youth Cycling, LLC dba Stowe Mountain Bike Academy, LLC and Vermont Mountain Bike Academy, LLC will keep this information confidential and will review the information solely to assess if requested accommodations are reasonable and do not fundamentally alter the serviced provided. Yes By checking this box I consent to this Release Statement: * I have read the cancellation policy and further understand that no part of the camp program fee is to be refunded in the event of dismissal or withdrawal due to illness, injury or unexpected family obligations. Yes By checking this box I consent to this Release Statement * I have read the behavior policy and code of conduct and reviewed these policies with my child. Yes Thank you!
