Register now for the new youth swim/run fitness event-AQUADASH! For current weather/program information call the MSCR Weather Line at 204-3044 or visit the weather section on this website. Problems with this site? Ideas for improvement? Contact Sharon Neylon at 204-3036 or sneylon@madison.k12.wi.us
  

Downhill Ski Request Form 2011

Participants Name:
Home Phone:

Experience:
(Check all items that apply)
I am a beginner skier/snowboarder
I have participated in this program before
I am an intermediate skier/snowboarder
I have never skied/snowboarded before
I am an advanced skier/snowboarder

Do you need standard equipment?

Do you need adaptive equipment or assistance?
Other (specify):

Are you signing up for lessons or open ski?

Helmet – All youth required to wear helmet. Adult usage optional – must sign below if electing not to wear a helmet.
If declining helmet, please initial here:

Disability (if applicable):

Bus Transportion:

Wheelchair:

Communication Style:

Medical Concerns/Allergies:

Medications and Medication Schedule:

Special Needs/Accommodations:

Primary Emergency Contact Information
Name:
Day Phone: Night Phone:
Alternate Emergency Contact Information
Name:
Day Phone: Night Phone: