Registration/Release Form

Complete the fields below, then click on the Print button to create the form. Read it, sign it and send it with payment, if applicable, to the ski trip or activity leader. Please make checks payable to KOPSC or King of Prussia Ski Club.

Check one:

Member   Non-Member 
  *Must be a member in good standing to participate in ski and sailing trips

Activity:  

Activity Date:   ( mm/dd/yyyy)
Name:  


(as it appears on your driver's license/picture ID)

Birth Date:   ( mm/dd/yyyy) Optional: and only needed for air line flight registration
Address:  

City:  

State:  

Zip Code:  

Evening Phone:  

- -

Day/Cell Phone:  

- -

E-mail:  


(leave blank if there is no e-mail address)

In event of emergency
Emergency Contact: 

Contact Phone:  

- -

Contact City:  

Contact State:  

Relationship:  

Please list any medical alert information or allergies / medications:  
 
   
Is this an overnight trip:   Yes     No 
Are you a Smoker:   Yes     No 

Preferred Roommate:  


(Courtesy dictates that you let them know of your request)
Other information needed for this trip or activity
(please refer to advertisement, e.g. ability level, t-shirt size etc.)