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Student Name :_______________________________________ Grade:____

Hedrick Ski and Ride Chaperone Application Thursdays after school- February 14 th , 21 st , 28 th ; March 7 th and 14 th. Student Name :_______________________________________ Grade:____ Briefly explain connection if you do not have a student participant:

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Student Name :_______________________________________ Grade:____

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  1. Hedrick Ski and Ride Chaperone ApplicationThursdays after school- February 14th, 21st, 28th; March 7th and 14th Student Name:_______________________________________ Grade:____ Briefly explain connection if you do not have a student participant: Chaperone Legal Name:____________________________________________ Male / Female Birthdate (must be 18 or over): ____________ emails _____________________________@____________________________ ____________________@_________ _____________________@_________ Thursday day #:___________________other #:___________________________ I can meet the busses outside Hedrick by 3:35 PM, ride the bus to the mountain, chaperone in the lodge or on the slopes, and ride the bus back to Hedrick at 9 PM (bus usually returns by 10PM) on these dates: February 14 February 21 February 28 March 7 March 14 An adult Lift ticket, a free ski or snowboard package rental, and of course, bus transportation for that evening are provided to the first few chaperones who commit to each evening. Early commitment will improve your chances of being sponsored. I plan on… Chaperoning on the bus and in the lodge Chaperoning on the bus and on the slopes Chaperoning on the bus and between lodge and slopes I have a season pass I have my own ski / snowboard package I will want a ski / snowboard package rental Page 1 of 2

  2. Hedrick Ski and Ride Chaperone ApplicationThursdays after school- February 14th, 21st, 28th; March 7th and 14th CRIM (Criminal Background Check) completed by Medford School District in the past three years If not, please return the completed CRIM form directly to Mr. Montgomery for Medford School District to process Volunteer in Medford Schools (VIMS) form completed this year (2012-2013) If not, please return the completed VIMS form to Mr. Montgomery for Hedrick to process Briefly describe any experience with Mt. Ashland Ski and Ride programs: Briefly describe any experiences chaperoning / supervising children at school: Briefly describe your level of abilities skiing or riding: Signature__________________________________________ Date___________ By signing, you are affirming that the information you provided is accurate. Page 2 of2

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