Yawgoo Valley Ski Patrol (YVSP)

Yawgoo Valley Ski Patrol (YVSP)

Membership Application Form
Applicant Information
Name*

First Name Last Name
Date of Birth*

MonthDay Year
Date
Alternate or Work Phone
Please enter a valid phone number.
Main Phone*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

City State

Zip Code
Email Address
example@example.com
Occupation
Student

YesNo
Employer
If Student, School
Employer Address
Grade/Year/Degree
Emergency Medical Training level EMT, RN, MD, Expiration Date

MonthDay Year
Date
Emergency Medical Training level EMT, RN, MD (license #, details)
Wilderness First Aid Training (level, course & date)
ICS Training (level, license #, expiration date)
National Ski Patrol (requires taking or challenging OEC exam)

New ApplicantTransfer from another patrol: PatrolReinstatement – Last year patrollingTransfer from another patrol: Patrol
First Aid/Medical/Special Skills Courses & Training (send copies of licenses)

None
NSP Number
Personal Details
Reinstatement – Last year patrolling
Last OEC Date

MonthDay Year
Date
Number of Seasons Downhill Skiing/Boarding Experience
Number of Seasons Downhill Skiing/Boarding Experience

Skiing Ability - NoviceIntermediateAdvanced
Do you have any physical disabilities that would limit physical activities?
Do you have any physical disabilities that would prevent you from lifting heavy objects?
Any medications or allergies you wish to bring to our attention?
Date of last physical (approximate)

MonthDay Year
Date
Physician (Name, Phone#)
Emergency Contact (Name, Phone)
(Address)
Reference/Referral Name & Phone
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

Clear
Signature of Parent/Guardian (if a minor)

Clear
Date

MonthDay Year
Date
Address
State
Home Phone
Zip Code
City
Name
Work
Mobile
Age
Should be Empty:

Yawgoo Valley Ski Patrol (YVSP)

Applicant Information

Personal Details