SKI ROUNDTOP RACE CLUB
2014-2015 REGISTRATION FORM
Registration Information:
1. All participants should be at least 8 years of age.
2. Intermediate skiing skills are necessary (parallel turns on most slopes) and be able to ride a chair lift without
assistance.
3. New athletes will be subject to observation by the coaching staff to assure they exhibit the skills necessary to
ski with the Club. Those who do not exhibit those skills will have all SRRC registration fees returned. (USSA
and PARA fees are non-refundable)
4. Use of approved ski helmet and medical alert label are required.
5. USSA Membership is REQUIRED for ALL ski and snowboard racers for insurance purposes. (USSA
Membership number required prior to any training activity with SRRC, including dryland training & offseason training camps.)
6. PARA Membership is REQUIRED for all ski racers, not snowboard racers. (For 2015, the PARA
membership fee is included in the online USSA application. – www.ussa.org)
7. USASA Membership fees required if racing snowboards competitively.
8. Participation in the SRRC Parent Volunteer Program is required. Each family must volunteer for a
minimum of (4) events including at least (1) PARA race and (1) Saturday Morning race.
Class Descriptions for Ski Racers: Age as of December 31, 2014: (* not eligible for Derby Race)
U21…… 18-20 yrs.
U18…… 16-17 yrs.
U16…… 14-15 yrs.
U14…… 12-13 yrs.
U12…… 10 & 11 yrs.
U10…… 9 yrs. & under*
Registration Fees:
Club Membership, Comp Center Maintenance and Hospitality Fee
(Mandatory for each family or individual) ………………………………………..$ 75.00
Competition Ski Team (Comp): weekend/2day ………………………………………………$435.00
Competition Plus Ski Team (Comp+): weekend plus Tues/Thurs…………………………….$535.00
Travel Ski Team (Travel)……………………………………………………………………...$635.00
Travel Plus Ski Team (Travel+): ………………………….
U16-U21 by Invitation only
Alpine Snowboard Team: 4 day (ST) ….…………………………………………………….. $635.00
Alpine SnowboardAlumni ...…..…………………………………………….……………….. $250.00
Birth
USSA
Racer’s Name
Sex
Class Program
Fee
Date
Number
Club Membership (Mandatory fee; only one $75 payment per family)
Discount fee of $25.00 by October 19, 2014
Tax Deductible Contribution to the SRRC General Fund (OPTIONAL)
Late Fee ($100 after 12/20/14 for returning members, $100 after 1/1/15 for all) NO
EXCEPTIONS
Total Fee and Donation Paid……………………………………………………
$ 75.00
$ –
$
$
Required per
family
One per
family
$
Completed forms should be mailed to Jon Tate, SRRC Registration Coordinator, 106 West Pomfret Street, Carlisle, PA 17013
and emailed to [email protected]
Family Information:
Father: _________________________________________ Primary Phone: (___)_________
Mother: ________________________________________ Primary Phone: (___)_________
Address: _________________________________________________________________
E-mail Address(s): _________________________________________________________
School District: ________________________________________Grade:______________
SRRC Medical Treatment Authorization
Racer #1: _____________________________________________ Birth date: _____________
Racer #2: _____________________________________________ Birth date: _____________
Racer #3: _____________________________________________ Birth date: _____________
Racer #4: _____________________________________________ Birth date: _____________
Health Insurance Co. and Policy/Group Number: _____________________________________
Contract ID of Policy Holder: ____________________________________________________
In case of an emergency contact: __________________________________________________
Emergency phone #1____________________ Emergency phone #2:_____________________
Name of Family Physician: ______________________________________________________
Address: __________________________________________Phone Number:______________
Preferred Hospital: _________________________________City:________________________
Please identify the following for each racer if applicable:
Medical Conditions: ____________________________________________________________
Allergies: ____________________________________________________________________
Daily Medications:_____________________________________________________________
Does skier wear contacts/glasses: Y N Other Pertinent Information:____________________
DELEGATION OF AUTHORITY TO CONSENT FOR HEALTH CARE
I hereby delegate my authority to consent for the health care of my son or daughter to a representative of the Ski
Roundtop Racing Club for periods of time when I am unavailable during a medical emergency. This authorization of
consent becomes effective on the date of my signature and remains in effect for a period of one calendar year.
Date: ____________ Signature:_______________________________________________
(Parent or Guardian)
Code of Conduct
Each racer and a parent must sign the following code of conduct as part of Registration.
As a member of the Ski Roundtop Racing Club, you will be a highly visible representative of the club. It is
important that you conduct yourself in a safe, mature and responsible manner at all times. Any failure to do so
will only serve to provide the general public, and the Roundtop Mountain Resort ski area management with a
negative image of the club, its members, coaches, officers and parents. To ensure your understanding of and
willingness to act in a safe and responsible manner at all times, please read and respect the contents of the SRRC
Team Handbook and read and sign the Ski Roundtop Racing Club Code of Conduct.
As a member of the Ski Roundtop Racing Club, I agree to:
1. Be on time for all Team activities at the designated meeting place.
2. Wear a protective ski helmet during all training and racing sessions.
3. Listen and be courteous and respectful to all SRRC Coaches, ski area employees/lift attendants, Ski Patrol
and Safety staff, and SRRC parents.
4. Treat teammates with courtesy, respect and in a manner in which I want to be treated.
5. Be appropriately dressed for weather conditions.
6. Maintain a level of academic performance satisfactory to school guidelines and to the expectations
of my parents/guardians.
7. Refrain from the use of inappropriate language at all times.
8. Help the SRRC Coaches when asked.
9. Treat all other skiers with respect.
10. Respect the race mountain facilities at all times.
11. Ski under control at all times.
12. Do my best in each and every activity.
13. I understand that failure to follow the Code of Conduct can result in verbal and/or written warnings from
coaches and Board action including suspension or removal from SRRC without refund.
14. Adhere to the SRRC Drug and Alcohol Policy.
_____________________________
Racer #1 Signature
_____________________________
Racer #2 Signature
_____________________________
Racer #3 Signature
_____________________________
Racer #4 Signature
____________________________
Parent Signature
____________________________
Parent Signature
____________________________
Parent Signature
____________________________
Parent Signature
SRRC U14 – U21 Drug/Alcohol Policy
ALCOHOL, STEROIDS, TOBACCO and DRUGS: Athletes shall abstain from the use, possession, manufacture,
transport and distribution of illegal drugs, including inappropriate use of prescription drugs, consumption of alcohol and any
form of tobacco at all times, including non-SRRC events, SRRC-sponsored activities, programs, trips, travel, camps,
competitions or other events. An illegal drug includes (without limitations) any illegal or controlled substance, as defined by
law, by an individual under the age of 21.
DISIPLINARY POLICIES: SRRC athletes who do not meet expectations will be subject to disciplinary action by one or
more of the following: Coaches, Program Director, Executive Board, Board of Directors or Competition Committee. Action
taken against an individual as a result of an infraction can include, but is not limited to reprimand, revocation of club
privileges, forfeiture of club benefits, suspension, dismissal and expulsion. Depending upon the severity of the incident,
permanent expulsion is possible – and can happen upon a first offense.
Example of permanent expulsion – Sale or Distribution of Alcohol and/or Illegal Drugs (including furnishing alcohol to any
person under the age of 21) is immediate dismissal from all SRRC programs. Expulsion means that the individual is
ineligible to participate in any SRRC sponsored activities, competitions, camps or other events permanently.
DRUG/ALCOHOL USE – First Offense Consequences may include, but not limited to:
Immediate suspension of at least 2 weeks
Review by Executive Board before consideration of re-instatement.
Participation & completion of substance abuse counseling
Verbal apology to team (age group specific)
Written essay to Coaches and Board Members
Competition Center Community service (trash removal, cleaning, etc.)
Random drug testing (payment is responsibility of parent/athlete)
DRUG/ALCOHOL USE – Second Offense Consequences may include, but not limited to:
Immediate suspension/dismissal for the remainder of season and/or permanent expulsion from all SRRC activities.
Review by Executive Board before consideration of re-instatement. It is solely the decision of the Executive Board as to the
nature of the violation that has occurred and the appropriate sanctions being suspension; dismissal or expulsion shall be
final.
Note: Individuals will be personally liable for any damage to the property of others incurred as a result of their actions.
Athlete signature______________________ Parent signature______________________ Date_______
SKI ROUNDTOP RACING CLUB
RELEASE AND INDEMNITY AGREEMENT
NOTICE AND ASSUMPTION OF RISK:
I specifically understand and agree that ski and snowboard racing and/or race training contains inherent and other risks that
could lead to serious, catastrophic injury or death. Said risks include, but are not limited to traveling at high rates of speed,
negotiating race gates, strenuous physical activity, collisions with other skiers, coaches or spectators, fencing and other natural
and/or manmade objects and carrying equipment while skiing/boarding and/or using lifts. Understanding these risks, I hereby
agree to ASSUME FOR MYSELF OR MY MINOR CHILD ALL OF THE RISK INVOLVED.
RELEASE OF LIABILITY:
I the undersigned, in consideration of being allowed to participate in the Ski Roundtop Racing Club and race related or
preparatory training activities thereof, do hereby AGREE NOT TO SUE and to release, the Ski Roundtop Racing Club,
Snow Time Inc., Ski Roundtop Operating Corp., Ski Liberty Operating Corp. and Whitetail Mountain Operating Corp.,
as well as their agents, officers and employees from any and all liability for past, present or future claims, actions or
damages without limitation, whether consisting of personal injury, property damage, or death that does or may result in
any way from my participation in the competitive sporting events, or preparatory training thereof, regardless of any
negligence, gross negligence or improper conduct on the part of the ski area.
I further agree to HOLD HARMLESS, INDEMNIFY AND DEFEND the same from any and all liability for past,
present or future claims, actions or damages without limitation, whether consisting of personal injury, property damage
or death that does or may result in any way from my or my child’s participation in the competitive sporting events or preparatory training thereof, regardless of any negligence, gross negligence or improper conduct on the part of the ski
area.
I further understand that, if I so desire, I may inspect all areas, courses or slopes involved in said competition or training prior to
use of the same, understanding that I am assuming any and all risks, responsibility and liability for use of the same.
I further understand and agree that the Ski Roundtop Race Club is an independent organization separate and in no way
employed by Ski Roundtop Operating Corp.
I further agree to abide by Your Responsibility Code and all ski area policies at all times when using said facility. Violations
will result in loss of privileges without warning or refund. Additionally, I hereby grant permission to the ski area, to use my
photograph, video tape, motion picture or other record of my use of the facility, for any legitimate purpose and hereby release all
rights to the same.
I further agree that all disputes arising under this contract shall be litigated exclusively in the Court of Common Pleas of York
County, Pennsylvania or in the United States District Court for the Middle District of Pennsylvania.
This agreement is governed by the applicable laws of this state. If any part of this agreement is determined to be unenforceable,
all other parts shall be given full force and effect.
I understand and agree that this release is binding not only upon myself, but also upon my heirs, administrators and executors in
reference to any claim they may have. I hereby execute this agreement understanding the conditions, terms and the totality of its
effect.
I HAVE READ AND UNDERSTAND THE ABOVE LIABILITY RELEASE AGREEMENT
_____________________________________________________________________
Participant’s Signature ____________________________
Date
_____________________________________________________________________
____________________________
Signature of Parent or Guardian
Date
(The signature of one parent/guardian binds both parents/guardians, in reference to this agreement)
lw14/15
SRRC Volunteer Program
SRRC is known throughout Central Pennsylvania for its active parental volunteer program; establishing a healthy
and successful race atmosphere for all racers. Therefore, in order to offer your racer the best support for his/her
efforts, the SRRC Board takes a “zero tolerance” stand of any parent who is unwilling to participate throughout the
season in the SRRC volunteer program. If volunteer slots need to be filled, an SRRC member will contact you to
solicit your assistance to fulfill your requirements. By volunteering, you enrich the lives of not only your child, but
all the racers in the club. In order to insure full compliance, we are continuing the volunteer points system this year.
Each family must volunteer for a minimum of four (4) events and (1) Saturday Morning race.
This year’s volunteer assignments will be available again through
www.timetosignup.com/srrcorg. Please watch the website and your email for
updates.
Dates to remember:
October 4 & October 5, 2014: World Cup Ski Swap
October 11 & October 12, 2014: Mountainside Ski Swap
Sunday, October 19, 2014: SRRC Race Season Kickoff and Registration Day: 2:00 – 6:00 pm @ The Comp
Center
October 27 – 31, 2014: Equipment Check in, Roundtop Mountain Resort Swap: 12:00PM to 8:00PM
November 1, 2014: Equipment Check in, Roundtop Mountain Resort Swap: 8:00AM to noon
November 1 & November 2, 2014: Roundtop Mountain Resort Ski Swap: 9:00AM to 5:00PM
November 2, 2014: Unsold Equipment Pick-up, Roundtop Mountain Resort Swap: Noon to 5:00PM
November 3, 2014: Unsold Equipment Pick-up, Roundtop Mountain Resort Swap: 6:00PM to 8:00PM
December 27-30, 2014: Christmas Camp
December 29, 2014: SRRC Team Photo Day
December 30, 2014: Christmas Camp Pizza Party
January 3, 2015: SRRC Saturday Morning Club Race #1 and 3rd Annual Biffvitational
Sunday, January 4, 2015: Richard Whitney Memorial PARA Race – U10-U21, U12-U14 Central Region
Qualifier, U16 – 21 USSA Scored Race
January 2015: USASA Snowboard Series races, dates to be determined
Sunday, February 1, 2015: Sheibley Memorial Dual GS PARA Race – U10-U14
March 8, 2015: Last SRRC Club Race
April 18, 2015: SRRC Awards Banquet
Registration Checklist (Please keep this page for your records)
To assure your racer(s) is properly registered, please check (X) the following:
______ Registration Check enclosed (checks should be made payable to: SRRC Membership)
______ Code of Conduct read and signed by both racer and parent/guardian
______ Drug and Alcohol policy read and signed by both racer and parent/guardian
______ Release and Indemnity Agreement signed by both racer and parent/guardian
______ Medical Treatment Authorization Form completed and signed by parent/guardian
______ $75 Club Membership, Comp Center Maintenance and Hospitality Fee (one per family)
Completed registration forms and applicable payment should be mailed to:
Jon Tate, SRRC Registration Coordinator
106 West Pomfret Street
Carlisle, PA 17013
Reminders: Registration deadline is December 20, 2014 for returning members.
Registration deadline for NEW members is December 31, 2014.
You must have a 2014-15 USSA number in order to register.
$25.00 discount by October 19, 2014. (NO EXCEPTIONS)
$100.00 late fee for returning members after December 20, 2014.
$100.00 late fee for all after January 1, 2015.
NO EXCEPTIONS RELATED TO LATE FEES!
SRRC reserves the right to refuse registrations received after January 1, 2015.
MARK YOUR CALENDARS NOW FOR THE START OF THE SEASON!
SRRC RACE SEASON KICKOFF AND REGISTRATION DAY
SUNDAY, OCTOBER 19, 2014
2:00 – 6:00 PM
Location: SRRC Comp Center
FOOD, FUN AND INFORMATION