ISLAND SKI TOURS
PHONE (631) 656-0982
FAX (631) 656-0984
BUS TRIP FORM FOR CONSENT & RELEASE OF LIABILITY & MEDICAL
INFORMATION
THIS FORM IS REQUIRED FOR ALL ANYONE GOING ON A TRIP THAT IS UNDER
18 AND NOT GOING WITH A PARENT OR LEGAL GUARDIAN. PLEASE FILL
THIS FORM OUT AND BRING IT WITH YOU ON THE BUS.
NAME:
_______________________________________________________________
ADDRESS: _____________________________________________________________
CITY: ____________________________________________
STATE: _____________
ZIP: ______________________
HOME PHONE#: ( ____ ) - _____ - __________
EMERGENCY PHONE#: ( ____ ) - _____ - __________
SOMEONE MUST BE AVAILABLE AT THE ABOVE # FOR THE DURATION OF THE
TRIP. INITIAL: _________
I UNDERSTAND THAT ISLAND SKI TOURS IS NOT RESPONSIBLE FOR ANY
INJURIES TO PERSONS AND OR DAMAGE TO PROPERTY SUSTAINED ON ITS
TRIPS . ISLAND SKI TOURS ONLY ACTS TO PROVIDE SERVICES AND HAS NO
DIRECT CONTOL OVER ASPECTS OF THE TRIP SUCH AS THE MOTORCOACH
AND OR THE SKI AREA.
INITIAL: _____________
PLEASE PROVIDE
MEDICAL INSURANCE COMPANY: __________________________________
POLICY#: __________________________________________
SIGNATURE OF PARENT OR GUARDIAN: __________________________________
DATE: _____________
IN THE EVENT OF A MEDICAL EMERGENCY THAT REQUIRES OFF SITE
TREATMENT, THE BUS CANNOT BE HELD AT THE END OF THE DAY.
AMBULANCE TRANSPORT THE RIDER'S RESPONSIBILITY