Renfrew Skating Club

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

Email *

Skater's First and Last Name *

Please select the program *

Can Skate 5:30

Can Skate 6:30

Parent and Tot * (Must answer next question)

Name and Address of Parent/Caregiver that will be on the ice (Must be the same person each week)

Sex *

Female

Male

Date of birth (d/m/y) *

Address *

Postal Code *

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 (we don't accept credit cards) *

Cash

E-transfer

Cheque

Other*

If you answered other please explain?

Fees and Schedule *

5:30 CanSkate $310

6:30 CanSkate $310

Parent/Tot $360

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

A copy of your responses will be emailed to the address you provided.

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