Domestic Partnership Statement

Domestic Partnership Statement

This statement of domestic partnership is to be completed by both the employee and the declared domestic partner.
We the undersigned attest to the following:
- each party is the sole domestic partner of the other.
- each party is at least eighteen (18) years of age or older.
- both parties currently share a common legal residence and have shared said residence for at least the previous six (6) months.
- neither party is married, a party to a Civil Union, or related to the other by adoption or blood to a degree of closeness that would bar marriage/Civil Union in the state in which they legally reside.
- both parties are in a relationship of mutual support, welfare caring, and commitment and intend to remain in such a relationship in the indefinite future.
- the parties are jointly responsible for basic living expenses (basic living expenses are defined as the cost of basic food, shelter, and any other expenses of the common household; the partners need not contribute equally or jointly to the payment of these expenses as long as they agree that both are responsible for them); and
- We are both competent to enter in a legally binding contract
SWORN STATEMENT

We declare that all the foregoing information provided by us is true and correct and that all provisions of this Statement have been met.

We understand that:
- If there is any change in the information certified in the Statement of Domestic Partnership that would make the domestic partner ineligible, the employee must notify Human Resources immediately.
Declaration of Domestic Partner
We have read and understand the terms and conditions contained in this Statement of Domestic Partnership. We understand that any misrepresentation of fact can result in the loss of pass privileges immediately, and the employee could be disciplined up to and including termination for misrepresentation of domestic partnership.
Employee First & Last Name*
Employee Signature*

Clear
Domestic Partner First & Last Name*
Domestic Partner Signature*

Clear
Address of Employee and Domestic Partner*
On what date did your domestic partnership begin?*
Employee's Email Address*
Required: provide one of the documents listed below to Human Resources to receive a season pass for your domestic partner.
- proof of common residence—e.g., driver’s licenses showing same address or designations for receipt of mail; and
- proof of financial interdependence—e.g., joint checking, savings, or credit card statements, executed powers of attorney, insurance policies, and/or copies of designated signatures on safety deposit boxes.
Upload one of the supporting documents listed above.*

Cancelof

Employee Identification Card / Season Pass Terms & Conditions of Use
Employee's First and Last Name*
Employee's Department*
1. My Employee ID/Season Pass is non-transferable and not for resale. I understand and acknowledge that all Resort privileges (hereinafter- skiing, snowboarding, mountain biking, lift access, summer adventure center activities, golf, etc.) shall terminate immediately if my Employee ID/Season Pass is used by anyone other than the person named thereon.
2. Misuse or violation of any of the terms of this Agreement, in any manner, may result in disciplinary action up to and including termination.
3. I realize that all Resort privileges are not part of my compensation from the company. I further realize that these Resort privileges bear certain inherent risks for which I assume full responsibility.
4. My Employee ID/Season Pass identifies me as an employee and allows me certain Resort privileges as detailed in the Employee Handbook. I understand that my Employee ID/Season Pass MUST BE READILY AVAILABLE and that I must present my Employee ID/Season Pass upon request to any authorized representative of Killington/Pico Ski Resort Partners, LLC.(hereinafter KPSRP) If my Employee ID/Season Pass is misplaced, lost, forgotten, left at home, or for any reason I am unable to display my Employee ID/Season Pass, I may be required to purchase a full price ticket and will not be eligible for any other applicable discounts until such time as I am able to display my Employee ID/Season Pass.
5. I understand and agree that if my exit from employment at Killington Resort or Pico Mountain is for any reason other than lay off, my Employee ID/Season Pass will be deactivated, and the privileges will no longer be available to myself or my eligible dependents.
6. All Season Pass holders are expected to observe certain rules and policies. Any of the following violations, as determined solely by KPSRP, may be grounds for total revocation of Resort privileges and I may become ineligible to have a pass issued or sold to me for a future season or seasons:
7. Failure to follow Your Responsibility Code/Mountain Bikers Responsibility Code as outlined in the Employee Handbook and the trail guide.
  1. Skiing, snowboarding and mountain biking at a speed and/or in a manner so as to not endanger others.
  2. Skiing, snowboarding and mountain biking beyond (1) opened and designated trails, (2) Closed Area signs, or (3) Area Boundary signs and trail guide markings.
  3. Failure to provide name and local and permanent address to first aid personnel and any other party involved in a collision that results in injury.
  4. Leaving the scene of an accident.
  5. Jumping out of lifts.
  6. Engaging in abusive or rude language and/or behavior on any Killington Resort or Pico Mountain premise.
  7. Engaging in activities for monetary gains that directly compete with the business of Killington/Pico Ski Resort Partners, LLC while on the premises of Killington Resort or Pico Mountain, including, but not limited to, the resale of lift products.
  8. Any other activities that KPSRP deem inappropriate and for any reason or no reason whatsoever.
8. I hereby acknowledge that I have read, understand, and will abide by the following terms and conditions of use of my Employee ID/Season Pass.
Employee Signature*

Clear
Date*

MonthDayYear
Date
LIST YOUR ELIGIBLE DEPENDENT(S) BELOW
Eligible dependents are a spouse or Vermont civil union partner and your dependent children 18 years and under residing with you.
Also, your dependent children who are under 25 years old, are full-time college students and, most of whose support is paid by you.
- SPOUSE - Legally married spouse.
- DOMESTIC PARTNERSHIP – Sole partners that are at least 18 years old, share a common legal residence for at least the preceding six (6) months, neither are married/in a Civil Union, related by adoption or blood, are in a committed relationship and intend to remain in such for the indefinite future, and both are responsible for basic living expenses. Proof of Domestic Partnership is required, and documentation must be submitted to Human Resources for approval.
- DEPENDENT CHILDREN UNDER 18 - A child of the eligible employee including natural child, legally adopted child, stepchild, children of an approved domestic partnership or child for whom legal guardianship has been granted. Grandchildren are not recognized for the purposes of establishing dependent status at KPSRP.
- DEPENDENT CHILDREN 18 OR OVER - Natural and legally adopted children of the employee who are full-time college students, aged 19 through 24.
Dependent Name *
Relationship to Employee
Employee Initials*
I certify that this dependent information is accurate according to the definitions above. I recognize that fraudulent representation of dependent status will result in my termination from KPSRP.
Should be Empty:

Domestic Partnership Statement

Employee Identification Card / Season Pass Terms & Conditions of Use