Renfrew Skating Club

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P.O. Box 872 Renfrew, Ontario K7V 4A6

Email *

Name of Skater *

Please select the program *

Advanced Can Skate

Intermediate

Senior A (Star 2 and up)

Senior B (Star 1)

Can Skate 6:30

Sex *

Female

Male

Date of birth (d/m/y) *

Address *

Township *

Mother's Name *

Mother's Phone Number *

Father's Name *

Father's Phone Number *

Emergency Contact (other than parent) *

Emergency Contact Phone Number: *

Does your child suffer from allergies? *

Does your child carry an epipen? *

Yes

Does your child have special needs?

The Renfrew Skating Club may use photos for publicity, such as the website and newspaper to generate awareness of our sport and acknowledge skaters achievements. Unless you select "OPT OUT", we may include your skater's name and image. *

Yes, I would like to OPT OUT

No, I do not wish to OPT OUT

Method of Payment *

Cash

E-transfer

Cheque

Other

Fees and Schedule *

Senior A $480 + 20 hours minimum PA hours + coaches fees

Senior B $480 + coaches fees

Intermediate $480

Advanced Can Skate $480

Can Skate $310

Required

All children in Can Skate program must wear hockey helmet with cage to participate

Required

Waiver *

The applicant acknowledges that participation in a skating program involves certain risks and may result in an injury, other than the above disclosures in the application. The applicant declares to be in proper physical condition and in good health to participate in the program. The applicant hereby waives all claims, rights or courses of action against the Renfrew Skating Club, it's officers, Directors, Coaches or Members from personal injury or loss of property of any nature or kind, however or whenever sustained. The skating committee or professionals have my permission to seek the necessary hospital, medical, surgical or dental treatments and to perform First Aid in case of accident.

Required

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