Pre-CanSkate Registration Form 2016/2017

LLOYDMINSTERSKATINGCLUB
Box1468! Lloydminster,SK! S9V1K4!www.lloydminsterskating.com WINTERSKATE:October3–December12
GROUPFORMAT:
Skaterswillhavegroup
lessonswithprofessional
coaches.
Askaterwillregisterfora
specificsession(1or2)from
October–Decemberand/or
January–March.
Pre-CanSkate
SkateCanada’s“Learn-to-skate
Program”designedforthose
whohaveneverbeenonskates
orarenotreadyforthefull
CanSkatecurriculum.
☐Pre-CanSkate1
$1201
Mondays5:15–5:45pm
☐Pre-CanSkate2
$1201
Mondays6:00–6:30pm
PleaseforwardfeesandcompletedformswithchequespayabletoLSCat:
LloydminsterSkatingClub!Box1468!Lloydminster,SK!S9V1K4
orsubmitthemduringtheLloydminsterCommunityRegistrationNighton
th
September8 between4:00and9:00pmattheServusSportsCentre(Multiplex).
☐SkateCanadaFee
CoversannualRegistrationandInsurance
andispayableonceperyear(September1
toAugust31).
$40
Ifpayingbycheque,pleasesubmit:
1chequeforPre-CanSkateProgramFees
PLEASENOTE:Apaymentplanoptionoftwoinstalmentsisavailable.50%ofthefeePLUSSkate
CanadaFeeisdueuponregistrationandtheremainderispaidviapost-datedcheque,dated
November1.
TOTALFEES=
$
st
REFUNDPOLICY:RefundswillonlybeissuedpriortoNovember1 unlessaccompaniedbya
Physician’snote.Allrefundsmustbesubmittedinwritingtolscinfo@lloydminsterskating.com.All
approvedrefundsaresubjecttoa$50administrationfee.Ifarefundisapproved,therefundwillbe
pro-ratedbasedonthenumberofavailableicesessionsupuntilwrittennoticeofwithdrawalis
received.
1
ThisfeeincludesthecostofoneFundraisingCouponBook,valuedat$25.
!AllCreditCardPaymentswillbesubjecttoa4%AdministrationFee!
!NSFChequeswillbechargedanadditional$50Fee!
FIRST NAME: ____________________________ LAST NAME: ______________________________
GENDER: ☐ Male
☐ Female
AGE: ______ DATE of BIRTH (mm/dd/yy): ______ / ______ / ______
FOROFFICEUSEONLY
PAYMENT TYPE:
☐ Full Fees Cheque #
☐ Credit Card
☐ Cash
☐ Cheque
☐ Fundraising Cheque # ____________
____________
PAYMENT PLAN:
☐ Sept Cheque # ____________ ☐ Nov Cheque # ____________
RECEIPT #: ______________
LSC SIGNATURE: _______________________________
DATE: __________________
LLOYDMINSTERSKATINGCLUB
Box1468! Lloydminster,SK! S9V1K4!www.lloydminsterskating.com WINTERSKATE:January9–March13
GROUPFORMAT:
Skaterswillhavegroup
lessonswithprofessional
coaches.
Askaterwillregisterfora
specificsession(1or2)from
October–Decemberand/or
January–March.
Pre-CanSkate
SkateCanada’s“Learn-to-skate
Program”designedforthose
whohaveneverbeenonskates
orarenotreadyforthefull
CanSkatecurriculum.
☐Pre-CanSkate1
$1201
Mondays5:15–5:45pm
☐Pre-CanSkate2
$1201
Mondays6:00–6:30pm
PleaseforwardfeesandcompletedformswithchequespayabletoLSCat:
LloydminsterSkatingClub!Box1468!Lloydminster,SK!S9V1K4
orsubmitthemduringtheLloydminsterCommunityRegistrationNighton
th
September8 between4:00and9:00pmattheServusSportsCentre(Multiplex).
☐SkateCanadaFee
CoversannualRegistrationandInsurance
andispayableonceperyear(September1
toAugust31).
$40
Ifpayingbycheque,pleasesubmit:
1chequeforPre-CanSkateProgramFees
PLEASENOTE:Apaymentplanoptionoftwoinstalmentsisavailable.50%ofthefeePLUSSkate
CanadaFeeisdueuponregistrationandtheremainderispaidviapost-datedcheque,datedFebruary
1.
TOTALFEES=
$
st
REFUNDPOLICY:RefundswillonlybeissuedpriortoFebruary1 unlessaccompaniedbyaPhysician’s
note.Allrefundsmustbesubmittedinwritingtolscinfo@lloydminsterskating.com.Allapproved
refundsaresubjecttoa$50administrationfee.Ifarefundisapproved,therefundwillbepro-rated
basedonthenumberofavailableicesessionsupuntilwrittennoticeofwithdrawalisreceived.
1
ThisfeeincludesthecostofoneFundraisingCouponBook,valuedat$25.
!AllCreditCardPaymentswillbesubjecttoa4%AdministrationFee!
!NSFChequeswillbechargedanadditional$50Fee!
FIRST NAME: ____________________________ LAST NAME: ______________________________
GENDER: ☐ Male
☐ Female
AGE: ______ DATE of BIRTH (mm/dd/yy): ______ / ______ / ______
FOROFFICEUSEONLY
PAYMENT TYPE:
☐ Full Fees Cheque #
☐ Credit Card
☐ Cash
☐ Cheque
☐ Fundraising Cheque # ____________
____________
PAYMENT PLAN:
☐ Jan Cheque # ____________ ☐ Feb Cheque # ____________
RECEIPT #: ______________
LSC SIGNATURE: _______________________________
DATE: __________________
LLOYDMINSTERSKATINGCLUB
Box1468! Lloydminster,SK! S9V1K4!www.lloydminsterskating.com Winter Skate 2016 Pre-CanSkate Registration Form
FIRST NAME: ____________________________ LAST NAME: ______________________________
GENDER: ☐ Male
☐ Female
AGE: ______ DATE of BIRTH (mm/dd/yy): ______ / ______ / ______
ADDRESS: _______________________________________ CITY: ___________________________
PROVINCE: _____ POSTAL CODE: _______ PARENT/GUARDIAN EMAIL: ___________________
HOME PHONE: (
) ____________________ ALTERNATE PHONE: (
) ___________________
SKATE CANADA #: (if known)____________________ HOME CLUB: __________________________
PARENT/LEGAL GUARDIAN NAME(S): _________________________________________________
EMERGENCY CONTACT #: _________________ HEALTH CARE #: __________________________
LIABILITYWAIVER&RELEASE
The Lloydminster Skating Club (LSC), formerly operating as the Lloydminster Figure Skating Club, shall not be liable for injury or loss
occasioned by the participant while traveling to or participating in skating practices, competitions, or other activities, nor shall the
LSC/LFSCandSkateCanadaberesponsibleforanydamagesorlossescausedbytheparticipant.Theparticipantorparent/legalguardian,
if participant is under 18 years of age, agrees to indemnify the LSC/LFSC and Skate Canada, and its directors, employees, volunteers,
coaches, officials, instructors, independent contractors, agents and sponsors, and hold it harmless for any claims or demands in such
respectoflossordamage.TheundersignedagreestoabidebyalltherulesoftheClubandSkateCanada,toberesponsible,andtopay
promptlyforalllessonsbookedbytheparticipant/parent/guardian.
FOIP/PHOTORELEASE
LSC/LFSCisrequiredtofollowtheprovisionsofTheFreedomofInformationandProtectionofPrivacy(FOIP)Act.Undertheseprovisions,
LSC/LFSC is only permitted to publish information about participants (skaters, coaches and volunteers) with written consent. If the
participant is under 18 years of age, the parent or guardian of the participant must sign on the minor's behalf.Publication includes
releasing the participant's name or image as related to competition results and inclusion in programs, posters, advertisements, the
LSC/LFSCwebsite,etc.
_________________________________________
Participant’s or Parent/Legal Guardian’s Signature
__________________________
Date