Yawgoo Valley Ski Patrol (YVSP)

Yawgoo Valley Ski Patrol (YVSP)

Membership Application Form
Applicant Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Main Phone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate or Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email Address
example@example.com
Occupation
Employer
Employer Address
Student
If Student, School
Grade/Year/Degree
Emergency Medical Training level EMT, RN, MD, Expiration Date

MonthDayYear
Date
National Ski Patrol Activity (requires taking or challenging OEC exam)
Emergency Medical Training Level | EMT, RN, MD (license #, details)
Wilderness First Aid Training (level, course & date)
ICS Training (level, license #, expiration date)
First Aid/Medical/Special Skills Courses & Training (send copies of licenses)
Transfer or Reinstatement
NSP Number
Reinstatement – Last year patrolling
Last OEC Date

MonthDayYear
Date
Personal Details
Number of Seasons Downhill Skiing/Boarding Experience
Specify sport type
Downhill Skiing/Boarding Ability Level
Do you have any physical disabilities that would limit physical activities or lifting heavy objects?
Do you have any physical disabilities that would prevent you from
Any medications or allergies you wish to bring to our attention?
Why would you like to be a Ski Patroler? What brings you to Yawgoo Valley?
Date of last physical (approximate)

MonthDayYear
Date
Physician (Name, Phone#)
Format: (000) 000-0000.
Physician Name, Practice Name
Emergency Contact (Name, Phone)
Format: (000) 000-0000.
Emergency Contact (Name, Phone)
(Address)
Personal Reference/Referral Name & Phone
Personal Reference/Referral Name & Phone
Format: (000) 000-0000.
I hereby apply for membership in the Yawgoo Valley Ski Patrol. I understand this application is for a volunteer position, and requires joining the National Ski Patrol (NSP) and paying associated annual dues. I have read the requirements and pledge to fulfill them, including all required NSP training. I agree to a background check conducted by either the YVSP or its approved delegates, and to abide by the rules and procedures outlined in the Yawgoo Valley Employee Handbook. Upon attaining registered membership, I pledge to respect the privileges of both YVSP and the National Ski Patrol, and to obtain and wear the appropriate uniforms while on duty after my candidacy period. I also agree not to drink alcoholic beverages nor be under the influence of alcohol, drugs and/or medications for at least eight (8) hours prior to or while on duty or when wearing any YVSP or NSP attire.
Signature of Applicant
Signature of Parent/Guardian (if a minor)
Date

MonthDayYear
Date
Address
State
Home Phone
Format: (000) 000-0000.
Zip Code
City
Name
Work
Mobile
Age
Should be Empty:

Yawgoo Valley Ski Patrol (YVSP)

Applicant Information

Transfer or Reinstatement

Personal Details