Waterloo Track 3

First Name^*

Last Name^*

Address

City

Postal Code

Phone

Email^*

Date of Birth

Do you want on hill or off hill?

Height in feet and inches

Preferred ski night first choice

Preferred ski night second choice

Preferred ski night third choice

Are you available during daytime hours for school programs?

Do you ski or snowboard?

Are you a Chicopee member?

Please list any volunteer experience you have or any other certifications

Emergency Contacts

Contact 1 Name

Contact 1 Phone

Contact 2 Name

Contact 2 Phone

Employment History

Employer's Name

Employer's Address

Job Title

Employment Start Date Employment End Date

Name of Supervisor

Supervisor Phone

Reason For Leaving

Reference Check Approval?

Duties/Responsibilities

References

Name of 1st Reference

Reference 1 Telephone

Reference 1 Relationship

Name of 2nd Reference

Reference 2 Telephone

Reference 2 Relationship

Additional Information