HOME SCHOOL 2009 SESSIONS

							                       DAY TIME LESSONS 2010
                          Registration Form
Event:     Ice Skating Lessons
Place:     S2 Ice Arena
Club:      Kalamazoo Figure Skating Club
Coaches: Jessica LaPorte & Hilary Armstrong
Time:      1:30 p.m. – 2:30 p.m.
Questions: Contact Jessica LaPorte at 353-9668
      Tuesdays:                                Thursdays:
Ice time is divided into three parts:                    Ice time is divided into two parts:
20 minutes of small group instruction                    30 minutes of small group instruction
10 minutes of private lesson instruction                 30 minutes of independent practice
30 minutes of independent practice
                 Skaters are put into groups according to level and interest.
Please circle the session you are registering for:
Session 1       Tuesday        January 12th – February 16th      Cost $55.00             6 wks
                Thursday       January 14th – February 18th      Cost $55.00             6 wks
Session 2       Tuesday        February 23rd – March 30th        Cost $55.00             6 wks
                Thursday       February 25th – April 1st         Cost $55.00             6 wks
Session 3       Tuesday        April 13th – May 18th             Cost $55.00             6 wks
                Thursday       April 15th – May 20th             Cost $55.00             6 wks
Session 4       Tuesday        May 25th – June 29th              Cost $55.00             6 wks
                Thursday       May 27th – July 1st               Cost $55.00             6 wks
   Skate Rental                 $1.00 Per skater / Per week / Payable to S2 Arena
   Discount                     $5.00 Off per skater for dual registration of a skater in
                                 both Tuesday & Thursday daytime skating lessons.
Total $__________        discount (if app.) $ __________         Amt. paid $____________
Name of Skater ________________________________________________
Age____________         Birth date ____________          Male _____      Female ___
Highest test passed:    Basic Badge _________ Freestyle _____________
United States Figure Skating Number: ______________
Additional Skater _______________________________________________
Age____________         Birth date ____________          Male _____      Female ___
Highest test passed:    Basic Badge _________ Freestyle _____________
United States Figure Skating Number: ______________
Name of Parent/Guardian ________________________________________
Address __________________________________               City ________________
State______ Zip__________ Phone number _________________________
Cell phone ______________________E-mail ________________________
Emergency Contact:       ___________________________________________________
                                   Please complete both pages
                                 INSURANCE WAIVER FORM

In consideration of my participation in U.S. Figure Skating program or Basic Skills activity, I
acknowledge that I understand the nature of the activity and that I, and/or my minor child, am
qualified, in good health, and in proper physical condition to participate in such activity. I
acknowledge that if conditions are unsafe, I, and/or my minor child will immediately discontinue
participation in the activity.

I fully understand that skating involves risks of serious bodily injury, including permanent
disability, paralysis, and death, and that these and other risks may be caused by my own actions,
or inactions, those of others participating in the event, the conditions in which the event takes
place, or the negligence of the Releases named below; and that there may be other risks either not
known to me or not foreseen at this time; and I fully accept and assume all such risks and all
responsibility for losses, costs, and damages I incur as a result of my participation in the activity.

I hereby release, discharge and covenant not to sue the U.S. Figure Skating Association, its
Member Clubs, their respective administrators, directors, agents, officers, volunteers, and
employees, and any sponsors and advertisers of any sanctioned event in which I participate (each
considered one of the Releases herein) from all liability, claims, demands, losses, or damages on
my account caused or alleged to be caused in whole or in part by the negligence of the Releases.
This release waiver of liability and express assumption of risk agreement does not apply to any
liability, claims, demands, losses, or damages arising out of the gross negligence of, or
intentional, willful or wanton misconduct of Releases. If I, or anyone on my and/or my minor
child’s behalf, makes a claim, I agree I will indemnify, defend, save, and hold harmless each of
the Releases from any loss, liability, damage, or cost which any may incur as the result of such
claim.

I acknowledge that I have read this release, waiver of liability and express assumption of risk
agreement and fully understand it.

__________________________________________                          __________________________
Participant Signature                                               Date

__________________________________________                          __________________________
Parent/Legal Guardian Signature                                     Date


                                    KFSC PHOTO RELEASE

As a participant, or parent/guardian of minor participant, in the KFSC or KFSC Basic Skills
Program, I understand that the KFSC, or its agents, may take photographs, video, and/or film of
my, my minor child’s, and/or my family’s involvement, participation, viewing or interaction at
KFSC scheduled ice time, activities, classes or events. I hereby authorize the taking and use of
such photographs, video, film or likeness of myself, my minor child (or children), and/or my
family in all forms and media and in all manners, including composite or other representations,
for any lawful and legitimate KFSC purpose, including dissemination and distribution of the
same; and further waive any right to approve or object to any finished, modified or derivative
product or media.

Parent/guardian name: _________________________________________________

Signature: ___________________________________________________________

Name of Minor Child (Children): _________________________________________

Date: _____________________________