Enfield & Canaan Recreation After School Program

Participant's First Name

Participant's Last Name

Participant's Age on 1/1/2023

Participant's School Enfield Village Canaan Elementary Indian River Mascoma High

Participant's Grade K 1 2 3 4 5 6 7 8 9 10 11 12

Lift Ability Learning the Magic Carpet Can independently ride the magic carpet Can independently ride the rope tow/poma Can independently ride the T-Bar Can independently ride the chairlift

Parent or Guardian's Name

Parent or Guardian's Phone Number

Parent or Guardian's Email Address

Emergency Contact Name (if different)

Emergency Contact Phone Number (if different)

Ski or Snowboard Ski Snowboard

Ski/Ride Ability Orange: Never participated in a snow sport Red: I have participated but I can't turn or stop yet Green: I can turn and stop on all GREEN terrain Blue: I can ski/ride all BLUE terrain well Black: I can ski/ride all BLACK terrain well

My child has permission to be dismissed early and ride the bus from their school to Whaleback Mountain Yes No

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Whaleback Mountain is proud to receive grant funding to support our after-school program from Share Winter Foundation. The following set of questions relate to data collected for the Share Winter Foundation. These questions are not required for registration but we very much appreciate your consideration in answering; no identifying information will be share with Share Winter. If you would prefer to answer these questions anonymously, please go to https://form.jotform.com/213254821572049 Thank you!

Participant will participate in (if applicable) Alpine Ski Snowboarding

Does the participant identify as Male Female Transgender, non-binary or gender non-conforming

Is the participant New - New to this program, but has past ski/ride experience in another program(s) Returning - Has participated in this program before Never-Ever - New to this program and has no prior ski/ride experience

Does the participant identify as African American Hispanic/Latinx Indigenous American or Native Alaskan Caucasian Native Hawaiian or Pacific Islander Two or More races/ethnicities Other Race/Ethnicity Prefer not to answer

Does the participant qualify for the Free and Reduced Lunch Program at School? Yes No

Annual Household Income of Participant Less than $40,000 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 More than $70,000 Prefer not to answer

At what skill level will the participant start the program? Beginner Intermediate Advanced

I am 18 or older, I understand all purchases are non-reundable and have reviewed and accept all terms of the Whaleback/UVSSF waiver: www.whaleback.com/waiver

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