UCSD VSA’s

“Winter Snowdown”Registration Packet

Big Bear MountainSaturday, Dec 12 – Monday Dec 14

Priority Deadline: Friday, December 4th

After Dec 4th, VSA Members will no longer receive sign-up priority. Spots will open for general participants (non-UCSD VSA members) on the Wait List.

Final Deadline: Monday, December 7th

For All ApplicationsPLEASE INCLUDE $25 DEPOSIT TO RESERVE YOUR SPOT

SPACE IS LIMITED (45 Max)

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Winter Snowdown hosted by UCSD VSA

Attendees are required to complete this application in its entirety to provide the necessary information to maximize their camp experience. Registration process will not be complete until full payment is received. Please print clearly to provide accurate information. Thank you!

For more information, email us at ucsdvsasnowtrip@gmail.com, visit our facebook event page, or call us:

Chris Cung 310-908-8209Christina Tran 858 717 4763Anna Huynh 714-261-5523

Registration Information1. Gender: Male Female2. Member Status: UCSD VSA member Non UCSD VSA member

st3. Year: 1

ndYr 2

rdYr 3

thYr 4 Yr 5

th(+) Yr

Alumni Graduate Other 4. VSA family (if applicable): Red Blue Orange Green Purple Yellow

Last Name*: First Name*: M.I. DOB* (mm/dd/yyyy): Mailing Address*:

City*: State*: Zip*: Phone*: Email*: AIM Screen Name:

Personal Info1. What is your major? 2. Which college are you from? 3. What is your hometown? 4. How did you hear about this Trip? Please check all that apply.

Family Email VSA/Vietnamese Org Facebook Friends Website Previous Attendee

5. Have you attended a VSA snow trip before? Please check one. Yes NoIf yes, how many times?

6. Spec i al Needs - If you have any special needs, please let us know here and we will try to accommodate you to the best of our ability. (For example - vegetarian meals, allergies, other medical concerns, etc…)

7. What do you hope to gain or accomplish from this snow trip?

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Registration FeePlease check one*: $95 Beginner $75 Novice $50 Non-Snowboarding

Package DetailBeginner - $95 Novice - $75 Non-Snow-er - $50• Food• Lodging• Transportation• 1 Lift Ticket (Big Bear &

Snow Summit)• Rentals• 2 Hours Group Lesson

**Please check which equipment rental you need: Skiing Snowboarding

• Food• Lodging• Transportation• 1 Lift Ticket (Big Bear &

Snow Summit)

• Food• Lodging• Transportation

• We accept both cash and checks. Please make checks payable to: UCSD VSA• Registration and $25 deposit due no later than December 7, 2009• Registration will not be accepted after December 7, 2009. You may contact us by the

contact information above to meet up and pay your deposit.• Please note that the registration process will not be completed until full payment is

received.

Event AccommodationSnow Trip 2009 will be held at Big Bear Mountain.Attendees will be lodging three (3) days and two (2) nights in a cabin. Breakfast, lunch, and dinner will also be provided throughout the entire camp. Please refer to the list ofrecommended & prohibited items when preparing for this trip.

Rides will be provided to transport attendees from UCSD SUNGOD PARKING LOT to the cabin. Costs of transportation are included in the registration fee. Please arrive 30 minutes before the scheduled pick-up time in order to check-in. Attendees who arrive late (after we depart) will be responsible for their own transportation to the cabin. There will be no refunds given if late.

Event ActivitiesWhite Elephant Gift Exchange: One of the highlights of our trip will be the White Elephant Gift Exchange. Please contribute a small gift ($5 limit) to participate. Have fun with choosing the gift! It can be serious, silly, or completely random. Please remember to bring your gift, wrapped, to the event.

If you have any concerns about this activity, please comment here and we’ll see what we can do. _ _

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Participation Waiver Form (required)

ACKNOWLEDGMENT, RELEASE, HOLD HARMLESS AND ASSUMPTION OF POTENTIAL RISK AGREEMENTI, the undersigned (Name of Student/Participant) wish

to (and if under 18 years of age, also my parent or guardian authorizes to) participate in UCSD VSA WINTER Snowdown 2009 .I understand and acknowledge that this Activity may be dangerous and hazardous and, by its very naturepose the potential risk of severe and serious physical and emotional injury/illness, or even death, to all individuals who participate in such Activity.I understand and acknowledge that in order to participate in this Activity, my son/daughter and I agree toASSUME ALL LIABILITY AND RESPONSIBILITY for any and all potential risks, injuries, or even death which may be associated with participation in such Activity.I represent and warrant that Student/Participant is mentally and physically fit, capable, able, and willing toparticipate in this Activity without any limitations.I understand, acknowledge, and agree that VSA, its trustees, agents, volunteers, or representatives shall not be liable for any injury/illness suffered by Student/Participant, which is incident to and/or associated with preparing for and/or participating in this Activity.I hereby release, discharge, indemnify, and agree to hold harmless VSA, its governing board, and each of their trustees, employees, agents, coaches, teachers, volunteers, and representatives free from any and allliability arising out of or in connection with Student/Participant’s participation in this Activity, including all related activity such as games, practices, training activities, trips and related exercise. For purpose ofthis RELEASE, liability means all claims, demands, losses, causes of action, suits, or judgments of any kind that Student/Participant or Student/Participant’s parents, guardians, heirs, executors, administrators, and assigns may have against VSA, and their trustees, agents, volunteers, and representatives because ofStudent/Participant’s personal, physical or emotional, injury, accident, illness, or death, or because of any loss of or damage to property that occurs to Student/Participant or his or her property duringStudent/Participant’s participation in the Activity that may result from any cause including but not limited to VSA’s, trustees’, agents’, volunteers’, or representatives’ own passive or active negligence or other acts other than fraud, willful misconduct or violation of the law.I acknowledge that I have carefully read this ACTIVITIES PARTICIPATION FORM and that Iunderstand the potential dangers incident to engaging in the Activity, am fully aware of the legal consequences of this agreement, and agree to its terms and understand I am waiving certain rights andassuming the risk of damage from my participation in the Activity.The undersigned understands and acknowledges that during the activities pictures, including video, may be taken of the undersigned, or my son or daughter, and with voice sound and may subsequently be usedin the promotion of future activities by VSA. I authorize the use of my name or my son or daughter’sname, and pictures including any accompanying voice, to be exhibited with or without advertising sponsorship as still photographs, transparencies, motion pictures, television, video or similar media and hereby release VSA, its trustees, officers, agents, and cooperating agencies from any and all claims for the taking and use of the same.

Student/Participant Signature Parent/Guardian Signature (if Participant is under the age of 18)

DateDate

A signed PARTICIPATION WAIVER must be on file with VSA before a Student/Participant will be allowed to participate in the above Activity. STUDENT/PARTICIPANTS AND/OR PARENTS OR GUARDIANS WHO DO NOT WISH TO ACCEPT THE RISKS DESCRIBED IN THIS AGREEMENT SHOULD NOT SIGN THIS AGREEMENT, AND WILL NOT BE ALLOWED TO PARTICIPATE.

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AUTHORIZATION FOR MEDICAL TREATMENTI, the undersigned (Name of Student/Participant)

wish to (and if under 18 years of age, also my parent or guardian authorizes to) participate in UCSD VSA WINTER Snowdown 2009 In order that I, my daughter/son may receive the necessary medical treatment in the event of an emergency whereby I, she/he may sustain injury or illness during participation in this activity, I authorize any school official to consent to and obtain necessary medical treatment, including x-rays, examination, anesthetic, medical or surgical diagnosis or treatment or hospitalcare for such an injury or illness during the activity and I herebyrelease, discharge, indemnify and agree to hold UVSA, governing board and each of their trustees, agents, volunteers, and representative harmless in the exercise of such authority. I further hereby acknowledge that neither UVSA nor any of the persons named above have any obligation to seek such treatment. Should the need arise, the following information may be given to any health care provider:EMERGENCY CONTACTS #1Parent(s) or guardian

(home phone)

(cell phone)OTHER CONTACTSAdult over the age of 21

(first name) (last)

(Relationship: i.e. neighbor, relative, etc.)

(home phone)

(cell phone)OTHER CONTACTSAdult over the age of 21

(first name) (last)

(Relationship: i.e. neighbor, relative, etc.)

(first name) (last)Check one: Father Mother Guardian

(home phone)

(cell phone)EMERGENCY CONTACTS #2Parent(s) or guardian

(first name) (last)Check one: Father Mother Guardian

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(home phone)

(cell phone)STUDENT’S PRIMARY PHYSICIAN

Name of Physician:Phone:

MEDICAL CONDITIONPlease list any medical conditions of the above student (asthma, diabetes, epilepsy, etc.)

_

Please list any allergies or allergic reactions to medications of the above student _

Please list any medications the above student is now taking

Other pertinent medical information

MEDICAL INSURANCECompany Policy No.:

I, or the undersigned parent/guardian, have read and understood the above Authorization for MedicalTreatment.

Signature of Participant Date

Signature of Parent/GuardianDate

(if Participant is under the age of 18)

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