Winter Weekend Getaway Sign Up Form

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IMPORTANT NOTE: January 26-28. There are a limited number of spots available. Cost is $150 for lodging, food, and transportation (provided by FOCUS drivers). If you are wanting to ski, snowboard, or go tubing, it will cost approximately $100-250 depending on what your needs are (more specific details to follow) and for tubing up to $30. Of course you do not need to ski or snowboard to enjoy the weekend! Deadline to register is 1/20/24

See more information at our website: https://sites.google.com/site/focuspdx/events/ski-trip

Email *

Preferred Name *

What name do you ask your friends to call you?

Surname (Family Name)
*

What is your family or surname (known as "last name" in the U.S.)?

Gender *

Female

Male

Other:

Home Country *

If you are in the U.S. on a passport, entry the country which issued your passport.

School or Workplace *

If you are a student, what school do you attend? If not a student, where do you work? or enter "N/A"

Phone Number *

Food #1
*

Some have food requirements that may exclude some or all animal-based protein. Please select the option that best describes your diet.

Non-Vegetarian - no restrictions regarding animal products

Non-Vegetarian, no beef or pork - animal products allowed, but no beef or pork.

Halal - food according to Halal requirements.

Kosher - food according to Kosher requirements

Pescatarian - no land animals, but fish allowed.

Vegetarian - no meat, egg or fish, but other animal products such as dairy allowed

Vegan - plant-based diet that excludes all animal products including dairy and honey.

Non-Vegetarian

Non-Vegetarian, no beef or pork

Halal

Kosher

Pescatarian

Vegetarian

Vegan

Other:

Food #2
*

Some have food intolerances such as lactose or gluten. Some have food allergies such as peanuts or shellfish. Please enter any food intolerances or allergies.

Family Members
*

Will spouse, children, parents also attend with you? If so, enter names of those who will come. Include the ages of the children. If there are other adults in your family (18 or over), they will need to complete this form as well.

No family members? enter "No"

Child Car Seats?

If you have children who require child car seats, do you have them? If you do not have them, enter the ages of those who require car seats

Will you be skiing/snowboarding (we will be sending separate info on this)? *

Will you be going tubing instead of skiing/snowboarding?

Option 1

Clear selection

Please read and verify you have done so.

1. In consideration for being accepted and allowed to participate in activities associated with FOCUS on the Portland State University campus and its program at that and other locations during the period of Sept 1, 2023 through Sept 1, 2024, I personally assume responsibility for my actions, and release FOCUS, its partner agencies and their trustees and employees from loss, injury or damage to myself or my property; provided that nothing contained herein shall excuse FOCUS, its partner agencies and their trustees and employees from responsibility to act with reasonable care for the safety of myself or my property.

2. I give permission to FOCUS to be photographed, recorded, and/or videotaped and to allow this material to be used for publicity.

3. I give permission to FOCUS to obtain medical assistance in the event of an emergency. This permission will include the administration of medicines, surgical treatment, X-ray examination or hospitalization as might be ordered by a licensed medical doctor. I release and discharge FOCUS, its partner agencies and their trustees and employees from any liability for any first aid rendered or treatment performed pursuant to this consent.

4. I understand that FOCUS has a hostage policy that states that FOCUS should not yield to demands, including the payment of ransom or other extortion, issued through the use of hostage taking or extortion. Any claim or dispute arising from or related to this release shall be settled by mediation and, if necessary, legally binding arbitration in accordance with the rules of a mutually agreed upon alternative dispute resolution service. Judgment upon an arbitration decision may be entered in any court otherwise having jurisdiction. These methods shall be the sole remedy for any controversy or claim arising out of this release and I expressly waive my right to file a lawsuit in any civil court against FOCUS for such dispute, except to enforce an arbitration decision. I certify that I am competent to sign this Release, and have done so voluntarily.

5. Any claim or dispute arising from or related to this release shall be settled by mediation and, if necessary, legally binding arbitration in accordance with the rules of a mutually agreed upon alternative dispute resolution service. Judgment upon an arbitration decision may be entered in any court otherwise having jurisdiction. These methods shall be the sole remedy for any controversy or claim arising out of this release and I expressly waive my right to file a lawsuit in any civil court against FOCUS for such dispute, except to enforce an arbitration decision. I certify that I am competent to sign this Release, and have done so voluntarily.

I have read and affirm the above release form

I have paid the $150 on the Paypal site for myself and Family.

Payment can be made through Paypal link on Winter Weekend webpage https://sites.google.com/site/focuspdx/events/ski-trips

yes

Clear selection

Digital signature and date
*

A copy of your responses will be emailed to the address you provided.

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