If you are registered for your ski appointment at Boyne Mountain, please print, fill out entirely, and bring to your appointment.  If your appointment is scheduled for Challenge Mountain Adaptive Recreational Facility, please click on link.  Challenge Mountain Registration Form.

Challenge Mountain of Walloon Hills, Inc.

2205 Springbrook Rd., Boyne Falls, MI 49713

231-535-2141 Lodge

Permission for Emergency Care

Volunteer/Client_____________________________________ Date_________________

Address____________________________________________Phone________________

City_______________________________________________State_____Zip_________

DOB_________________

Parent/Guardian__________________________________________________________

Address____________________________________________State_____Zip_________

Emergency Contact______________________Relationship__________Phone_________

Medical Insurance Plan _____________________________ID#_____________________

Name of Physician _____________________________Physician Phone______________

I _________________________________hereby give my permission for emergency care to be sought and given to myself or above named dependant in the event that I cannot be contacted.

Age____________________                          for Challenge Mtn use only

Height__________________                          Ski length ____________ID#______________

Weight _________________                          Boot Sole Length ______ID#______________

Street Boot Size__________                            Ski Boot Size _________ID#______________

Disability____________________________________________________________________

Tech Initials_________________

Release of Liability/Consent

I am aware that injury or even death may occur to participants in this event.  I fully assume the risk of any and all such injuries to myself or my participating dependant.  I may or may not have inspected the equipment, site, and facilities.  Nevertheless, I assume all risk associated with this event, and my participation in it, including but not limited to the conditions of the equipment, site, facilities, and the unknown ability of other participants.  Furthermore, Challenge Mountain maintains volunteers on staff that have received citizen level CPR and first aid training.  These volunteers act solely on their own accord and Challenge Mountain will not be held liable for their actions.  The acts are covered under the State of Michigan Good Sanitarian precedent law releasing them of liability upon acting within the level of their training.  Challenge Mountain will maintain infection control, first aid, and barrier protection.

It is my express intent, by signing this release and participating in this event, to waive, relinquish, and release any claims which I might have against any and all volunteers, directors, executive director, officers, agents, and employees of Challenge Mountain of Walloon Hills, INC., and also the organization called Challenge Mountain of Walloon Hills, INC.  I intend this Release of Liability to be effective against me, my spouse, and my heirs, successors, and assignees.

By signing the Release of Liability, I signify that I have read and understand it.  I also understand that my participation is dependant upon my knowing and voluntary execution of this Release of Liability.

Print Name_____________________________________DOB_____________________

Signature ______________________________________Date Signed________________

Address_________________________________________________________________

City___________________________________________State_____Zip_____________