GMA Registration Form

Membership Registration
Current USSA general ($20) or competitor membership required for participation in any camp or program. Memberships expire 6/30 each year, register or renew at USSA.org.
Parent/Guardian Name *

First Name Last Name
E-mail *
Athlete Name *

First Name Last Name
Athlete Email (if different)
example@example.com
USSA Member # (Required unless one day event. To register visit https://my.ussa.org/)
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Athlete date of birth *

Month Day Year
Date
Parent Phone Number *
athlete phone number
Emergency contact *

First Name Last Name
Emergency contact Phone Number *

Area Code Phone Number
Does athlete have any allergies, medical or medication issues of which we should be aware? *
Click the days/programs you will be joining (Check all that apply): *

Academy Program (Grades 7-12) Tues-Fri, Sat/Sun Academy Program (Grades 7-12) Tues-Thurs, Sat/Sun Weekend Program (Ages 9-17) 1/2 Day Fridays Weekend Program (Ages 9-17) Full Day Fridays Weekend Program (Ages 9-17) Saturdays(SNBD Waitlist) Weekend Program (Ages 9-17) Sundays (SNBD Waitlist) Jr. Development (Ages 6-9) Saturdays (SKI IS FULL) Jr. Development (Ages 6-9) Sundays (SKI IS FULL) Friday Program (8 afternoons to coincide with Stowe School District - SKI IS FULL) GMA Membership (Incl. w/ all programs, This option to do drop ins only)
Will athlete be skiing or snowboarding? *

please let us know where you would prefer to focus your training:

	Very Interested	Interested	Somewhat Interested	Not Interested
Slopestyle
Skicross/Boardercross
Moguls/All Mtn/Trees.
Half Pipe
Competition

WAIVER, RELEASE, ASSUMPTION OF RISK, AND AUTHORIZATION FOR MEDICAL RELEASE IN CONSIDERATION OF MY CHILD’S ACCEPTANCE TO BE COACHED AND TRAINED BY GREEN MOUNTAIN ACADEMY, INC. AND ENTRY AND PARTICIPATION IN ANY AND ALL SESSIONS, PROGRAMS, EVENTS, CAMPS AND RACES, I HEREBY WAIVE, RELEASE AND DISCHARGE ANY AND ALL CLAIMS FOR DAMAGES FOR DEATH, PERSONAL INJURY, OR PROPERTY DAMAGE WHICH I OR MY CHILD MAY HAVE, OR WHICH MAY ACCRUE TO ME OR MY CHILD, AS A RESULT OF MY CHILD’S PARTICIPATION IN SUCH EVENTS. THIS RELEASE IS INTENDED TO DISCHARGE, IN ADVANCE, THE DIRECTORS, MEMBERS, AGENTS, COACHES, AND EMPLOYEES OF GREEN MOUNTAIN ACADEMY, INC. AGAINST ANY AND ALL LIABILITY ARISING OUT OF OR CONNECTED IN ANY WAY WITH MY CHILD’S PARTICIPATION IN THESE EVENTS. I FURTHER UNDERSTAND THAT SERIOUS ACCIDENTS AND DEATH OCCASIONALLY OCCUR DURING SNOWBOARDING AND SKIING ACTIVITIES. KNOWING THE RISKS OF SNOWBOARDING AND SKIING AND RELATED ACTIVITIES, I HEREBY AGREE TO ASSUME THOSE RISKS AND TO RELEASE AND HOLD HARMLESS ALL OF THE AFOREMENTIONED PERSONS AND ENTITIES. FURTHERMORE, I GIVE MY CONSENT FOR THE ADMINISTRATION OF ANY EMERGENCY MEDICAL TREATMENT DEEMED NECESSARY, IN THE EVENT THAT TREATMENT IS REQUIRED, AS A RESULT OF MY CHILD’S PARTICIPATION IN THE AFOREMENTIONED EVENTS. FURTHERMORE, I AGREE THAT THIS WAIVER, RELEASE, AND ASSUMPTION OF RISK SHALL BE BINDING UPON MY HEIRS AND ASSIGNS. I FURTHER STATE THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE CHILD NAMED BELOW. *
Please type full name of athlete here.
Parent/Guardian Signature *

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Membership Registration