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OLGC Youth Ministry Presents…

Teens in grades 9-12 are invited to join us for a trip to Whitetail Ski Resort (Mercersburg, Pennsylvania)
on Saturday, February 12th! Beginners, experts, and everything in between are welcome.

Space on this trip is limited, and we want a sell-out! Bring your friends – they don’t need to be part of
OLGC to attend this trip – and it is first-come first-served. Registration is due no later than Monday,
February 7th, 2011. To register, fill out all attached paperwork, make sure your parents sign where they
need to, and send it to us with payment at the address below.

Departure: Sat., Feb. 12 @ 6:00a from OLGC Parking Lot
Return: Sat., Feb. 12 @ 8:00p to OLGC Parking Lot
Cost: Various packages available, see next page
Transportation: Luxury Coach Bus
Notes: Lunch is part of all packages, no other meals included
Deadline to Register: Monday, February 7th, 2011

Send Forms & Payment to: OLGC Youth Ministry SKI TRIP, PO Box 97, Vienna, VA 22183

Questions? Contact Anthony ( or Christy ( or 703.896.7409


Complete this registration form and attached permission slip.
Mail with payment to: OLGC Youth Ministry SKI TRIP, PO Box 97, Vienna, VA 22183


Child’s Last Name Child’s First Name

Child Cell Phone Child Email Address

Date of Birth (MM/DD/YY) Current School Current Grade

Mother’s Name Father’s Name

Mother’s Contact Phone Father’s Contact Phone

Mother’s Email Address Father’s Email Address

Check this box if you are willing and able to serve as a chaperone for this trip:
(chaperones must have completed background check & VIRTUS requirements) □
NOTE – chaperones do not have to be able to ski.

Which package would you like? (Please check one)

□ $100 LIFT TICKET ONLY (Includes only the lift ticket, transportation on coach, and lunch. This ticket gives
you access to all trails, but you must bring your own equipment.)

□ $115 LEARN TO SKI or BOARD + EQUIPMENT (Includes the lift ticket, ski or snowboard rental, 90 minute
lesson*, transportation on coach, and lunch. This ticket only allows access to part of the mountain.)

□ $130 ALL MOUNTAIN + EQUIPMENT (Includes the lift ticket, ski or snowboard rental, 90 minute lesson*,
transportation on coach, and lunch. This ticket allows access to the entire mountain.)

* - The lesson is based on stated skill level, it is not just “beginner’s only.”

** - Do you have a season pass or Advantage Card to Whitetail? We have a special price for you. Contact
Anthony (703.896.7409 or for details.

□ HELMET RENTAL - We strongly advise that all teens wear a helmet. The risk of severe head injury is present
during this activity. Helmet rental is $9 additional. Please check this box to confirm helmet rental and be sure to
add this cost to your package cost.

We recommend rental insurance to anyone who is renting equipment. This is $1 paid at the time of rental pickup
and should be handled by each teen on their own. Teens may also wish to bring cash for any additional purchases
made on site.

Cancellation policy: As we still have to pay for the bus and group costs regardless of our final numbers, refunds will
only be available if you cancel at least 48 hours prior to the trip. Please note that regardless of cancellation date, $35
of your cost is non-refundable.

I hereby register child for SKI TRIP 2011 at Whitetail Ski Resort (Mercersburg, PA) on February 12, 2011. I have
enclosed a check made out to OLGC YM in the amount of $_____ to cover the cost of this trip.

Parent Signature: _____________________________________


As the parent/legal guardian of ____________________________ permission is hereby given for my child to participate in the high school
Youth Ministry trip to Whitetail Ski Resort (Mercersburg, PA) with OLGC Youth Ministry on Saturday, February 12th, with departure scheduled
of 6:00a and an approximate return time of 8:00p.

I understand and acknowledge that participation in the activities involves inherent risks of injury to my child. I agree to indemnify the Parish,
Youth Ministers, Volunteers, and the Diocese of Arlington for any costs or expenses arising out of my child’s participation in the activities
including the cost of any medical care given my child or any expenses or fees incurred in any lawsuit arising as a result of any damage or injuries
caused by my child in the course of his or her participation in the activity.

I further give my consent to that in my absence the above-named minor be admitted to any hospital or medical facility for diagnosis and
treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such
licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the
above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to
dispose of any specimen or tissue taken from the above-named minor.

Please print legibly:

Child’s Last Name Child’s First Name

Date of Birth Date of last Tetanus Booster

Known allergies including any allergies to medicine (Continue on back of form if needed)

Any other medical problems which should be noted (Continue on back of form if needed)

Name of Parent/Guardian

Address City/State/Zip

Phone Home Work Mobile

Person responsible for charges (if different from above)

Address City/State/Zip

Phone Home Work Mobile

Person to notify if parent/guardian is unavailable

Phone Home Work Mobile

Family Physician Phone

Insurance Carrier & Policy Number Name of Policy Holder

Signature of Parent Date

Signature of Witness Date