Free Club Waiver of Liability Form by uzm58517

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									                            StarSkate 2010-2011 Program
                         Metcalfe Skating Club, Box 201, Metcalfe,ON K0A 2P0
                         Please make cheques payable to Metcalfe Skating Club
Skater Information (one form per skater)            Fields marked with * are mandatory information
for Skate Canada
Skater's Name:*                                                          Skate Canada #:
 Day & Weeks                                                              Per Session    Package
                  Time                Session              Program                                       Fee
   Offered                                                                   Price        Price**
                   4:00-4:25         Dance/Skills          StarSkate
                                                                           $225.00
                   4:25-5:00          Freeskate            StarSkate
                   5:00-5:15           Stroking            StarSkate                     $405.00     $
                   5:15-5:40          Freeskate            StarSkate       $225.00
    MON
  23 Weeks         5:40-6:00        Dance/Skills           StarSkate
                                 Group Lesson 4 min
                                                                           $225.00                   $
                   4:00-5:00    Dance/Skills/Freeskate     Special Jr.
                                                                                         $405.00
                                 Group Lesson 4 min
                                                                           $225.00
                   5:00-6:00    Dance/Skills/Freeskate     Special Jr.
                   5:00-5:25         Dance/Skills          StarSkate
                                                                           $225.00
                   5:25-5:55          Freeskate            StarSkate
                   5:55-6:10           Stroking            StarSkate                     $405.00     $
                   6:10-6:30          Freeskate            StarSkate       $225.00
    WED
                   6:30-6:50         Dance/Skills          StarSkate
  23 Weeks
                   5:00-5:55     Group Lesson 4 min        Special Jr.     $225.00
                                Dance/Skills/Freeskate
                                                                                         $405.00     $
                   5:55-6:50     Group Lesson 4 min        Special Jr.     $225.00
                                Dance/Skills/Freeskate
                   7:20-8:20         Freeskate             StarSkate       $225.00       $225.00     $
    THUR
  23 Weeks                       Group Lesson 4 min
                                                           Special Jr.     $225.00       $225.00     $
                   7:20-8:20    Dance/Skills/Freeskate
                   6:00-6:55          Freeskate            StarSkate       $215.00
                                                                                         $390.00     $
                   6:55-7:50          Freeskate            StarSkate       $215.00
     FRI                         Group Lesson 4 min                        $215.00
  22 Weeks         6:00-6:55    Dance/Skills/Freeskate     Special Jr.
                                                                                         $390.00     $
                                 Group Lesson 4 min                        $215.00
                   6:55-7:50    Dance/Skills/Freeskate     Special Jr.
** Each skater will receive a package price if 2 hourly sessions
                                                                      Subtotal:                      $
are registered for the same day.
*** Additional discounts based on: 1) # of hourly sessions
registered (3 Hrs - 20%, 4 Hrs - 25%, 5 Hrs - 30%, 6 Hrs - 35%, Discount***:                   (If
                                                                                                     $
7 Hrs - 40%); 2) # of skaters in family (if 3rd skater registered -   applicable)
10%).
Are you registered with a different club? Yes____ or No____                     Subtotal:            $
Oct 1st                        Amount:                   Cheque #         Skate Canada Fee
                                                                             (mandatory)                 $31.00
Nov 1st                        Amount:                   Cheque #
                                                                                 Total               $
Dec 1st                        Amount:                   Cheque #

Note: A $25.00 administration fee will be charged for any NSF cheques. Refunds will only be issued
BEFORE the third class of the session.
                                     Star Skate Registration Form
                               Make Cheque Payable to Metcalfe Skating Club.
Skater's Last Name:                                    Skater's First Name

Male / Female                                  Birth Date (dd/mm/yy)

Address:

Postal Code: **                                               Phone number

Email Address:**

                                               Name(s):
Emergency Contact Information:
                                               Phone:

                                               Yes:
Medical Conditions: Please List
                                               No:
                                               Yes:
I am (was) registered with a different club,
(If yes, please enter club name):
                                               No:
                                               Free Skate:

Level of Skater: please indicate highest       Dance:
level passed)
                                               Skills:

Coches Name:                                                  Skate Canada #

Program Registed For:

                                                Club Use Only
Cheque #                                       Amount

Registration Date:

Arena Registered:                 Metcalfe ( )                 Fred Barrett ( )
Details           KinderSkate ( ) CanSkate ( )                               StarSkate ( ) Special Jr. ( )
Monday            6:00 - 6:25 ( ) 6:00 - 6:50 ( )             Monday         4:00-5:00 ( ) 5:00-6:00 ( )
                                                              Wednesda
                  6:25 - 6:50 ( )                                      5:00-6:00 ( ) 6:00-6:50 ( )
                                                              y
Thursday          6:30 - 6:55 ( ) 6:30 - 7:20 ( )             Thursday 7:20-8:20 ( )
                  6:55 - 7:20 ( )                             Friday   6:00-7:00 ( ) 7:00-7:50 ( )
Skater's Name                                               Date:
Medical Information:
Session Registered for: CanSkate (            ) KinderSkate (    ) StarSkate (     ) Special Jr. (      )
Monday 4:00:5:00 ( ) or 5:00-6:00 (  ) or Both ( )          Thursday 7:20-8:20 ( )
Monday 6:00 ( ) or 6:25 ( )                                 Thursday 6:30 ( ) or 6:55 ( )
Wednesday 5:00-6:00 ( ) or 6:00-6:50 (    ) or Both (   )   Friday 6:00-7:00 ( ) or 7:00-7:50 (   ) or Both (   )
Waiver Of Liability:
 I, the undersigned, assume all risk & hazard usual to such participation, including transportation to and from
activities I, do hereby waive results, absolve, indemnify, and agree to hold harmless the Metcalfe Skating Club
(MSC), its sponsors, supervisors, participants, executive and other person's arising out of injury to the above
participant whether the result of negligence or for any other cause. I authorize MSC to collect and use the
personal data on this form to administer the programs for which the applicant has enrolled.



Signature of Skater or Parent/Guardian, if under 18



Photo Waiver:
The Metcalfe Skating Club use photos for publicity, such as in a pamphlet or on our website. This is
to generate awareness of our sport and celebrate achievements in skating. Unless you circle "OPT-
OUT, " we may use the skater's image.



                                        OPT-OUT
Signature of Skater or Parent/Guardian, if under 18




Harness Waiver
I, the undersigned, assume all risk and hazard to such participation, while using the skating harness
installed at the Larry Robinson Arena in Metcalfe. I, do hereby waive results, absolve, indemnify, and
agree to hold harmless the Metcalfe Skating Club (MSC), its sponsors, supervisors, participants,
executive, and other persons arising out of injury to the skate named below, whether the result of
negligence or for any other cause.


Signature of Skater or Parent/Guardian, if under 18

								
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