Glissad Skating Club Annual Holiday Ice Show 2014

Glissad Skating Club Annual Holiday Ice Show 2014
Sunday, December 28, 2014 at 3:45 pm; Iceland Ice Rink
Sanctioned by US Figure Skating
Tickets to our exciting show will be available at the door the day of the show!
Tickets will be $5.00 each and children under 3 are free!
REGISTRATION
Glissad Skating Club Members - $20.00 per program
Non-members (Associate, Learn to Skate, etc) - $30.00 per program
Group numbers (2 or more skaters) - $15.00 per program
Skater Name __________________________________________________________________________
Email ____________________________________________ Phone # ____________________________
USFSA level _______________________________ Coaches name_______________________________
Music Program #1 ______________________________________________________________________
Music Program #2 ______________________________________________________________________
ADS – BLACK AND WHITE ONLY
Want to place a shout out in our Holiday Show Program? We are offering the following ads!
½ page ad - $20.00
¼ page ad - $10.00
2 line shout-out - $5.00
PAYMENT
Please return this registration form and payment to your coach or any Learn to Skate Instructor by
Saturday, December 6, 2014 (deadline enforced). In addition, the program/skating order is FINAL and
there will be no further changes made to the schedule.
Glissad Skating Club Members - #of programs _____ x $20 = $_____
Non-members (Associates, LTS, etc) - # of programs _____ x $30 = $_____
Group programs (2 or more skaters) - # of programs _____ x $15 = $ _____
½ page ad (please email ad to Jenn Schaffener) - # of ads _____ x $20 = $ _____
¼ page ad (please email ad to Jenn Schaffener) - # of ads _____ x $10 = $ _____
2 line shout out (please email ad to Jenn Schaffener) - # of ads _____ x $5 = $ _____
FOR MORE INFORMATION
Eleanor Reiss
Eleanorskate8@yahoo.com
732-489-2930
Donna Console
pinksk8s@aol.com
609-220-8188
Jennifer Schaffener
jschaffener@icloud.com
609-712-1077
Accident/Liability/Photo Release: I, or my son/daughter or child over whom I have legal custody, wish to participate
in classes/activities organized by Glissad Skating Club. I agree to release Glissad Skating Club, and/or their
members, employees, agents, representatives, sponsors, affiliates and/or subsidiaries, from all claims, actions, causes
of action or damages suffered by me or my son/daughter or child over whom I have custody for any loss or injury
resulting from participation in the aforesaid classes/activities. I understand that by participating in a Glissad Skating
Club program, I or my child could be injured, die and/or suffer property damage. Regardless of bodily injury, death
or property damage sustained by me or my child from participating in a Glissad Skating Club program, I agree not to
sue, or allow others to sue on my behalf. I understand that photographs and/or video of me or my child may be taken
during the show rehearsals and performances, and that these images may be used for promotional purposes.
Parent Signature ________________ Skater Signature __________________ Date _______________