Educational Shadow Request Form Shadow request forms must be submitted 2-weeks in advance of the event. Completion of this form does not confirm your request has been approved. Shadow Applicant InformationNAME* First Last EMAIL* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country PHONE*Are you a current member of PSIA-AASI?*YesNoPSIA-AASI Member ID Number*Name of other Professional Organization Affiliation*Are you currently a member of PSIA-AASI Education Staff*YesNoShadow Event InformationPlease email firstname.lastname@example.org if you have questions regarding this form or event details.Event Discipline*AlpineSnowboardChildren's SpecialistSenior SpecialistAdaptiveTelemarkCross CountryFreestyleExam Type*Level 1Level 2Level 2 TeachLevel 3Level 3 TeachLocation*Start Date* End Date* Shadowing Guidelines and ExpectationsWhen shadowing please remember you are there to observe as an understudy only. Please exercise the demos and tasks, but be advised that you will not receive feedback with the rest of the group.Your insights may or may not be asked for. We welcome your questions, but please be mindful of your timing and don't ask in front of the rest of the group. Suggestions on timing include: on a chair ride, if it is only you and the examiner; at lunch; after the day is over and the examiner has finished group feedback.There may be times when the candidates ask your opinion; this can be a delicate situation as your role in the event is to observe as an understudy. Please only repeat what the examiner has said and suggest that they ask for additional clarification from the examiner at the next stop.We want this to be an educational experience for you, however your reasons for attending are not the same as the paying attendees. Please be mindful and respectful of their needs. Examiner Role and Expectations with Shadow:-Debrief expectations with shadow before exam start.-If an exam, review 'exam outline' together (which should help ensure examiner organization).-Shadow can be tasked on a low level administrative duty, such as check-in, if helpful.-When group is assembled, Examiner will introduce shadow to group and briefly explain shadow's observational/understudy role.-Examiner 'best practices' should be shared with shadow when time permits.-Shadow follows examiner directives and does not offer commentary.Shadowing Guideline Acknowledgement* I have read the Shadowing Guidelines and Expectations as outlined above and understand my role as an understudy for this event.Western Division Event Cancellation Policy*Western Division reserves the right to cancel any event if it lacks registration by the published date. If an event you are intending to Shadow is cancelled, we will do our best to re-schedule your shadow request in a timely manner.WaiverI am voluntarily participating in a Ski/Snowboard Event (hereinafter “Event”) held by the Professional Ski Instructors of American-Western Division, also doing business as American Association of Snowboard Instructors-Western Division (hereinafter “PSIA/AASIW”). In consideration for being permitted to participate in the Event, I, for myself, my heirs, executors, administrators, and assigns, waive and release any and all rights and claims including any claim of negligence I may have or accrue against PSIA/AASI-W, and any other sponsors or co-sponsors, or their officers, representatives, agents, employees, successors and assigns (hereinafter collectively the “Released Parties”) for any and all liability, claims, demands or causes of action that I may hereafter have for injuries, damages or death that I may suffer as a result of my participation in the Event, including the use of equipment provided to me and use of facilities.I am an experienced skier/snowboarder and instructor and am aware of the risks of snowsports and risks of participating in PSIA/AASI-W events and training including, but not limited to, use of equipment in a manner not intended by the manufacturer and body movements not intended for the general public. I understand and acknowledge that involvement in the Event and all potential activities associated therewith have inherent risks as well as risks that may be created or increased by actions or negligence of others and I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY SUSTAINED WHILE PARTICIPATING IN THE EVENT WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.I agree to INDEMNITY AND HOLD THE RELEASED PARTIES HARMLESS from all claims, judgments, and costs, including attorney’s fees, incurred in connection with any action brought as a result of my participation in the Event. I will take full responsibility for, and hold harmless the Released Parties from any injury that I may suffer or inflict upon others or their property as a result of my participating in the Event.I further represent that I am at least 18 years old, or that as the parent or (adult) legal guardian, I waive and release any and all legal rights that may accrue to me, to my minor child or the minor child for whom I am (adult) legal guardian, as the result of any injury that my minor child, the minor child for whom I am (adult) legal guardian or I may suffer while engaging in the Event and all activities associated with the Event.I hereby acknowledge that this Release of Liability, Waiver of Legal Rights and Assumption of Risk is a contract pursuant to which I have released any and all claims against the Released Parties resulting from participating in the Event including any claims of negligence of the Released Parties.Media Release* I agree that my participation in the Event includes having my image photographed, videographed and published and authorize PSIA/AASI-W to take and publish such images for use in PSIA/AASI-W print, online and video-based marketing materials as well as any other PSIA/AASI-W publications. I agree that taking and publication of my image does not confer in me any right of ownership, right to royalties or right to any form of financial compensation.Waiver Release of Liability & Cancellation Policy* I have read this Waiver and Release of Liability and the Refund and Cancellation Policy and Agree to it’s terms.Date* MM DD YYYYSignature/Release*I DECLARE: I AM AN EXPERIENCED SKIER/SNOWBOARDER AND INSTRUCTOR, l WISH TO PARTICIPATE IN THIS EVENT. lN CONSIDERATION OF ACCEPTANCE TO AND PARTICIPATION IN THIS EVENT, I HEREBY WAVE, RELEASE AND FOREVER DISCHARGE THE SKI AREA, PSIA·W, EXAMINERS. EMPLOYEES. AGENTS, MEMBERS, SPONSORS AND ALL OTHER PERSONS CONNECTED WITH THIS EVENT FROM ANY AND ALL LIABILITY FOR INJURY, DAMAGE OR DEATH, CAUSED BY THE NEGLIGENCE OR OTHER UNINTENTlONAL CONDUCT. l AM AWARE OF THE RISKS OF SKllNG/SNOWBOARDING, INCLUDING SERIOUS INJURY AND DEATH. I AGREE TO ASSUME ALL RISKS AND TO RELEASE ALL PERSONS ABOVE FROM ANY LIABILITY FOR NEGLIGENCE OR OTHERWISE ACTIONABLE CONDUCT.I HAVE FULLY READ AND VOLUNTARILY AGREE TO THE ABOVE TERMS AND CONDITIONSNameThis field is for validation purposes and should be left unchanged.