Online Registration

Athlete First Name

Last Name

Birth Date

Gender (Male or Female)

Address (Street or P.O. Box)

City

State

Parent/Guardian #1 Name

Parent/Guardian #1 Home Phone (xxx) xxx-xxxx

Parent/Guardian #1 Work Phone (xxx) xxx-xxxx

Parent/Guardian #1 Cell Phone (xxx) xxx-xxxx

Parent/Guardian #2 Name

Parent/Guardian #2 Home Phone (xxx) xxx-xxxx

Parent/Guardian #2 Work Phone (xxx) xxx-xxxx

Parent/Guardian #2 Cell Phone (xxx) xxx-xxxx

Existing Medical Conditions

Present Medications

Allergies

School

Grade

How did you hear about SSRA?

I have read the SSRA assumption & acceptance of risk, release & idemnity and agree to the terms. By clicking the box, I am verifying by electronic signature that I have read and accept the release on the back of the SSRA enrollment form.

Click for YESClick For No

Medical Insurance

Policy #

Insurance Phone (xxx) xxx-xxxx

Physician

Physician Phone (xxx) xxx-xxxx

Emergency Contact

Emergency Contact Cell Phone (xxx) xxx-xxxx

I have read and understand the concussion form information as found on www.gossra.org. I understand that coaches will act in accordance with the Lystedt Law to minimize the risk of second impact syndrome.

Click for YES Click For No

Medical Release: I, the parent/guardian, give the directors and coaches of the Spokane Ski Racing Association permission to obtain medical aid for my child in case of injury.

Click for YESClick For No

I understand that I am joining a team. I understand that I must adhere to the SSRA Codes of Conduct as found on www.gossra.org. I understand that team membership is a privilege that can be revoked at any time.

Click for YESClick For No

I understand that SSRA is a dependent of membership volunteerism. I agree to participate in fundraisers and volunteer as specified on the SSRA Volunteer Form found on www.gossra.org.

Click for YES Click For No

Which part of the team will your child be joining?

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Online Registration

SSRA Team Registration