VAC USE ONLY

_____ VAC Paid

2015-2016 WINTER CLIMBING TEAM

(Climber Information, Financial Agreement and Liability Release)

Climber Information:

First Name_________________________ Last Name_________________ DOB________        Adult Shirt Size _____

OR Kid’s Shirt Size _____

Larry’s

approval

Team (circle one):   Development Team ($650)          Junior A-Team ($650)           A-Team ($900)

Parent(s) Information: 

First Name________________________________________ Last Name_________________________________

Mailing Address______________________________________ City ______________ State _____ Zip ________

Phone__________________________ Email ______________________________________________________

*Credit Card Number_______________________________________________________   Exp ______________

Financial Agreement:

_____ Please immediately charge my credit card listed above for the FULL payment.

_____ DEVO/JR. A-TEAM:  Please immediately take a deposit of $150 and recurring monthly payments of

$100 for the remaining balance

_____ A-TEAM:  Please immediately take a deposit of $300 deposit and recurring monthly payments of

$100 for the remaining balance.

Guardian’s Signature of understanding__________________________________________ Date____________

Liability Release

·  I understand there are risks involved, both known and unknown, in entering a health club or participating in any exercise program.

·  I am requesting entry into Vail Athletic Club’s facility and/or exercise programs and represent that I am in good physical condition and I assume all risks of injury, including but not limited to physical strain, injury, or accident.

·  I intend to be legally bound and do hereby waive and release all rights and claims for damages I might accrue against Vail Athletic Club, its employees, affiliates, instructors, trainers, and officers, their successors, representatives, or assigns, for any and all injuries suffered by me while using Vail Athletic Club facilities or participating in its exercise programs.

·  I understand that Vail Athletic Club will not accept any legal or financial responsibility for any lost or stolen personal belongings, and that I assume all risks of bringing to the facility any money, jewelry, valuables, or other goods.

Guardian’s Signature of understanding__________________________________________ Date____________

Printed name_____________________________________________