Ski weeks application

Southland Ski Club

2019 Ski Week Package

Package includes 5 day lift ticket/pass, lessons twice a day (Mon-Fri), accommodation & meals.

Registration Details

How many children do you want to register?*

1234

Child One

Child One - Physical Address:*

Street Number / Name

Suburb

CityPost Code

Preferred Ski Week

Week 1 - Sunday 7th July until Friday 12th JulyWeek 2 - Sunday 14th July until Friday 19th July

If we are over subscribed on your preferred week are you able to swap to the other week listed:

YesNo

I wish to hire equipment through NZSki (10% discount on skis/poles/boots/snowboards/clothing/helmet)

YesNo

Medical Details

Child One - Medical Details

Family Doctor:*

Clinic Address:

Street Number / Name

Suburb

CityPost Code

Clinic Phone Number:

Area CodePhone Number

Pre-existing medical conditions:*

Medication:*

(Medication must be clearly labelled with instructions for storage & use)

General health: *

Do you have any special dietary requirements?

YesNo

Dietary requirements:

Please give full details - a hut parent will contact you to discuss meal plans for the week:

Other conditions or information:

Emergency Contact - Full Name:

First NameLast Name

Emergency Contact - Phone No. Landline:

Area CodePhone Number

Emergency Contact - Phone No. Mobile:

Area CodePhone Number

Emergency Contact - Address

Street number / name

Suburb

CityPost Code

I give permission:

In the event of an accident or sickness, I authorise the hut parents in charge to apply basic first aid including administering paracetamol if required.Ski patrol medics & the usual emergency services are available for more serious circumstances. I acknowledge that as soon as they are able, the hut parents in charge will make it a priority to advise me (us) of any more serious accident, injury or sickness of my child using the contact details provided in this application form.

Children that are unwell are not to attend ski week. A refund of the NZSki component may be given on receipt of a medical certificate. A refund of the catering & incidental component will depend on the time of the cancellation & will be at the committee’s discretion. An estimated charge of medical treatment at Coronet Peak or at Queenstown Medical Centre could be $50 for accidents or $100 for non-accidental medical treatment. Food and accommodation costs are not refundable after 20th June.

Child Two

Physical Address:*

Street Number / Name

Suburb

CityPost Code

Preferred Ski Week

Week 1 - Sunday 7th July until Friday 12th JulyWeek 2 - Sunday 14th July until Friday 19th July

If we are over subscribed on your preferred week are you able to swap to the other week listed:

YesNo

I wish to hire equipment through NZSki (10% discount on skis/poles/boots/snowboards/clothing/helmet)

YesNo

Child Two - Medical Details

Family Doctor:*

Clinic Address:

Street Number / Name

Suburb

CityPost Code

Clinic Phone Number:

Area CodePhone Number

Pre-existing medical conditions:*

Medication:*

(Medication must be clearly labelled with instructions for storage & use)

General health: *

Do you have any special dietary requirements?

YesNo

Dietary requirements:

Please give full details - a hut parent will contact you to discuss meal plans for the week:

Other conditions or information:

Emergency Contact - Full Name:

First NameLast Name

Emergency Contact - Phone No. Landline:

Area CodePhone Number

Emergency Contact - Phone No. Mobile:

Area CodePhone Number

Emergency Contact - Address

Street number / name

Suburb

CityPost Code

I give permission:

In the event of an accident or sickness, I authorise the hut parents in charge to apply basic first aid including administering paracetamol if required.Ski patrol medics & the usual emergency services are available for more serious circumstances. I acknowledge that as soon as they are able, the hut parents in charge will make it a priority to advise me (us) of any more serious accident, injury or sickness of my child using the contact details provided in this application form.

Children that are unwell are not to attend ski week. A refund of the NZSki component may be given on receipt of a medical certificate. A refund of the catering & incidental component will depend on the time of the cancellation & will be at the committee’s discretion. An estimated charge of medical treatment at Coronet Peak or at Queenstown Medical Centre could be $50 for accidents or $100 for non-accidental medical treatment. Food and accommodation costs are not refundable after 20th June.

Child Three

Physical Address:*

Street Number / Name

Suburb

CityPost Code

Preferred Ski Week

Week 1 - Sunday 7th July until Friday 12th JulyWeek 2 - Sunday 14th July until Friday 19th July

If we are over subscribed on your preferred week are you able to swap to the other week listed:

YesNo

I wish to hire equipment through NZSki (10% discount on skis/poles/boots/snowboards/clothing/helmet)

YesNo

Child Three - Medical Details

Family Doctor:*

Clinic Address:

Street Number / Name

Suburb

CityPost Code

Clinic Phone Number:

Area CodePhone Number

Pre-existing medical conditions:*

Medication:*

(Medication must be clearly labelled with instructions for storage & use)

General health: *

Do you have any special dietary requirements?

YesNo

Dietary requirements:

Please give full details - a hut parent will contact you to discuss meal plans for the week:

Other conditions or information:

Emergency Contact - Full Name:

First NameLast Name

Emergency Contact - Phone No. Landline:

Area CodePhone Number

Emergency Contact - Phone No. Mobile:

Area CodePhone Number

Emergency Contact - Address

Street number / name

Suburb

CityPost Code

I give permission:

In the event of an accident or sickness, I authorise the hut parents in charge to apply basic first aid including administering paracetamol if required.Ski patrol medics & the usual emergency services are available for more serious circumstances. I acknowledge that as soon as they are able, the hut parents in charge will make it a priority to advise me (us) of any more serious accident, injury or sickness of my child using the contact details provided in this application form.

Children that are unwell are not to attend ski week. A refund of the NZSki component may be given on receipt of a medical certificate. A refund of the catering & incidental component will depend on the time of the cancellation & will be at the committee’s discretion. An estimated charge of medical treatment at Coronet Peak or at Queenstown Medical Centre could be $50 for accidents or $100 for non-accidental medical treatment. Food and accommodation costs are not refundable after 20th June.

Child Four

Physical Address:*

Street Number / Name

Suburb

CityPost Code

Preferred Ski Week

Week 1 - Sunday 7th July until Friday 12th JulyWeek 2 - Sunday 14th July until Friday 19th July

If we are over subscribed on your preferred week are you able to swap to the other week listed:

YesNo

I wish to hire equipment through NZSki (10% discount on skis/poles/boots/snowboards/clothing/helmet)

YesNo

Child Four - Medical Details

Family Doctor:*

Clinic Address:

Street Number / Name

Suburb

CityPost Code

Clinic Phone Number:

Area CodePhone Number

Pre-existing medical conditions:*

Medication:*

(Medication must be clearly labelled with instructions for storage & use)

General health: *

Do you have any special dietary requirements?

YesNo

Dietary requirements:

Please give full details - a hut parent will contact you to discuss meal plans for the week:

Other conditions or information:

Emergency Contact - Full Name:

First NameLast Name

Emergency Contact - Phone No. Landline:

Area CodePhone Number

Emergency Contact - Phone No. Mobile:

Area CodePhone Number

Emergency Contact - Address

Street number / name

Suburb

CityPost Code

I give permission:

In the event of an accident or sickness, I authorise the hut parents in charge to apply basic first aid including administering paracetamol if required.Ski patrol medics & the usual emergency services are available for more serious circumstances. I acknowledge that as soon as they are able, the hut parents in charge will make it a priority to advise me (us) of any more serious accident, injury or sickness of my child using the contact details provided in this application form.

Children that are unwell are not to attend ski week. A refund of the NZSki component may be given on receipt of a medical certificate. A refund of the catering & incidental component will depend on the time of the cancellation & will be at the committee’s discretion. An estimated charge of medical treatment at Coronet Peak or at Queenstown Medical Centre could be $50 for accidents or $100 for non-accidental medical treatment. Food and accommodation costs are not refundable after 20th June.

* As well as filling in our form, you will also need to complete the NZSki Kids online booking form.

Parental Help Details

Please note all parental help stay free of charge at the lodge (meals/accommodation) in recognition of their help.

For Fulltime helpers we can also arrange skiing/boarding via the club for the week.

Please note there is no guarantee we can take all offers of parental help (pending numbers of participants in each ski week), you will be notified by 31 May if you have been chosen to attend as a part time or fulltime helper. Fulltime helpers will only then be invoiced for skiing/boarding fees.

Southland Ski Club are required to complete Police checks on all parents who wish to stay at the Lodge during Ski Week.

Can you help on Ski Week camp?*

YesNo

If you clicked 'Yes' please fill in a NZSki Adult booking form >>

Parental Help - Police Check

Full Name:

Given NamesFamily Name

Gender:

MaleFemale

Date of Birth:

Date

Place of Birth:

NZ Drivers Licence No:

Previous names if applicable, please include other alias or alternative names; married name if not your primary name; previous maiden or name changed by deed poll or statutory declaration:

Permanent Residential Address:

Street Number / Name

Suburb

City/Town/Rural DistrictPost Code

Address (if different to participant physical address):

Street Address

Street Address Line 2

City

Postal Code

What special Skills/Expertise can you offer as parent help?

Fulltime helpers indicate which week or if part-time which nights you will be staying:

	Full Week	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday
Week 1
Week 2

Do you have any special Dietary requirements or is there any medical conditions we need to be aware of?

Ski Club Membership

All ski week participants must be members of the Southland Ski Club – which membership would you prefer?*

Junior/Student membership $30 pa (18 yrs or under and/or still attending school or full-time tertiary studies)Adult/Senior membership $45 pa (18 yrs and over, not attending school)Couple membership $75 pa (adult couple residing at the same address)Family membership $95 pa (one or both spouses, children attending school or full-time tertiary studies)

Please note as you have completed Membership Details within the ski week application, you are not required to complete a seperate membership form.

How did you find out about the Southland Ski Club July Ski Week Camps?

A deposit of $250 per participant is required to secure their place on ski week. Payment is to be made on or before 10 June 2019.

Bank Account details - Westpac 03-0931-0256645-00

Please include 'Ski Wk Dep' in Particulars and Family name in Reference section.

Once your application and deposit are received your application will be processed and an invoice will be emailed to you for the balance owing, full payment must be made by 24 June 2019.

Ski week deposits are non refundable after 17 June 2019. All other refunds are at committee discretion and are assessed on a case by case basis.

I authorise:

I authorise the use of photographic images of ski week participants for promotional purposes.

Checklist:*

Ensure you have paid a $250 deposit per participantPrint off a suggested gear list