Registration Form for

Roberts Memorial Ski Lessons & Race

at Keyes Peak Ski Hill, Saturday, January 27th, 2018

Student’s name _______________________________________________

Address _____________________________________________________

State & Zip __________________________________________________

Parent’s name _______________________________________________

Parent’s cell number __________________________________________

Emergency contact # for 1/27/18 ________________________________

Student’s age ________ Has he/she skied before (yes) ____ (no) ____

How did you hear about this event?______________________________

Registration is first come first served capped at 75 students

Student can do just morning lessons 9-11:30 am, not required to do the ski races 12:30-3pm

A complete registration must include this form, the 2 waiver forms and $10 per student in cash or

check made payable to Keyes Peak Ski Hill Committee. $20 maximum per family. Submit to school

secretary; drop off at Florence Natural Resource & Visitor Center on corner of US 2 and Hwy 70 or

mail to Lori Moore, 5628 Forestry Drive, Florence, WI 54121.

All race participants receive a medal plus Gold, Silver and Bronze medals awarded in 6 age categories

for both male and female (age categories: 6-7//8-9//10-11//12-13//14-15//16-17)

Fastest racer of the day awarded Mike Roberts Memorial Trophy

For questions please call 715-528-5377 ext. 101

For event flyer go to www.ExploreFlorenceCounty.com, click on Ski Race Event at bottom

Please thank our local sponsors:

Roberts Memorial Ski Races at Keyes Peak Competition Release of Liability 2018

PLEASE READ CAREFULLY BEFORE SIGNING. THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS

Of my own free will, I agree to enter and compete in the Mike Roberts Memorial Ski Race competition at Keyes Peak Ski Hill under the terms contained hereinafter. I understand that snowboarding/skiing and this competition involve risks, dangers, and hazards that may cause serious personal injury or death and those injuries are a common and ordinary occurrence in this sport and in competition. Risk include, but are not limited to, falls, changes in terrain, weather and snow surfaces, ice, bare spots, debris, fences, posts, signs, lift towers, padded and non-padded barriers and obstacles, collisions with other persons and other natural and man-made hazards, and improperly adjusted or malfunctioning equipment. I freely accept and assume the risks associated with snowboarding/skiing and this competition. I represent I posses the necessary skills and physical ability to compete in this competition in such a manner that I will not endanger myself, other competitors, spectators or other persons. I understand that as a snowboarder/skier, I am bound by certain Wisconsin state laws and the Skier Responsibility Code (know as Your Responsibility Code). I understand it is my responsibility to inspect the terrain features and their associated terrain, including the angle and length of their approaches, take-off ramps and landing areas, prior to competing, to avoid falls and collisions, and to avoid injury to myself and others. I understand I am responsible for inspection and maintenance of my equipment. I agree to use restrain devices and/or leashes at all times. I further understand no inverted aerial maneuvers are allowed. In consideration of the permission to compete in the Mike Roberts Memorial Ski Race competition, and I hereby HOLD HARMLESS, and agree not to bring any action against the FLORENCE COUNTY AND ITS EMPLOYEES, KEYES PEAK SKI HILL COMMITTEE AND ITS MEMBERS RELEASEES for any personal injury or damage sustained by me, including death, while participating in this competition. In accordance with Wisconsin law, nothing in this Release of Liability should be construed as releasing, discharging or waiving claims I may have for reckless or intentional acts on the part of FLORENCE COUNTY AND KEYES PEAK SKI HILL COMMITTEE RELEASEE. I HAVE CAREFULLY READ THIS COMPETITION RELEASE OF LIABILITY AND UNDERSTAND ITS CONTENTS. I AM AWARE THAT BY SIGINING THIS COMPETITION RELEASE OF LIABILITY, I AM WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE KEYES PEAK SKI HILL, ITS OWNERS, OFFICERS, SHAREHOLDERS, AGENTS, EMPLOYEES, VOLUNTEERS AND THE KEYES PEAK SKI HILL COMMITTEE AND ITS MEMBERS FOR CERTAIN CLAIMS.

CAUTION: READ BEFORE SIGNING! THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS AND WILL BAR YOUR RIGHT TO SUE!

Competitor’s Name (print):________________________________Age:_______ Date of Birth(if under 18):_______________ Address:______________________________________________City: ___________________State:____ Zip Code_________ Competitor’s Signature:__________________________________________________________Date:____________________ PARENT AGREEMENT As parent and/or legal guardian of the above-named competitor, I hereby give permission for my child or ward to participate in the Roberts Memorial Ski Race completion at Keyes Peak Ski Hill. I have read and understand the above MIKE ROBERTS MEMORIAL SKI RACES AT KEYES PEAK COMPETITION RELEASE OF LIABILITY and, on my behalf and on behalf of my child or ward, I agree to all terms contained therein. I represent I have full authority to sign on behalf of my child or ward, realizing this Release of Liability is binding upon my child or ward as well as myself. I, on behalf of myself and my child or ward, agree not to bring any action or lawsuit against Keyes Peak Ski Hill, its owners, officers, shareholders, agents, employees, or volunteers and the Keyes Peak Ski Hill Committee and its members for any injury or damage sustained by my child. Parent’s or Legal Guardians’ Signature*:___________________________________ _______ Date:_______________________ *Parent or Guardian signature must accompany minor signature.

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Compcttmr's Name (ha) ,4P Dale (~lundEr 18)

PARENT AGREEMENT

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