Iced Energy Tryouts 2017-2018

 

Registration Form

 

 

Intermediate/Novice - Flat Fee: $ 40.00  š

 

Paid by:         Cheque š                Cash  š         Date: __________________

 

 

Skater: _____________________________________________________________________

                                    (First Name)                                          (Last Name)

 

Parent(s) Name: _____________________________________________________________

                                    (First Name)                                          (Last Name)

 

Home Phone #:  ___________________________     Cell #:  ____________________________

 

 

Parent email: _______________________Alternate email: ___________________________

 

 

Home Address:   _____________________________________________________________

                                    House #                                       Street Name                                              Apt/Unit #

 

Town/City: __________________________________ Postal Code: ____________________

 

 

Birthdate:      ________/_______/________    Age as of July 1, 2017: ___________________

                            Day           Month          Year

 

Skate Canada #: ___________________Home Club Name: ___________________________

(All Skaters MUST have a current & valid Skate Canada #)

 

SKATING HISTORY

 

Home Club:  ___________________________________

 

Highest level StarSkate Tests passed as of today’s date:

 

Dance: ____________________ Skills:  _________________ Freeskate: _______________

 

Synchronized Team Experience

 

Number of Years:  ____________________________

 

Previous Team(s): 

 

_____________________________________________________________

                                                            Team Name(s) and Level (s)

 

 

 

 


Signature Required - Please turnover!!

 

 

 

 

 

 

1.  Are you trying out or have you tried out with a different club for the 2017/2018 season?  If yes, please indicate club and team level:

 

___________________________________________________________________________

 

___________________________________________________________________________

 

 

2.  If you are successful at tryouts, are you committed to joining the team?

 

___________________________________________________________________________

 

 

3.  Please list three (3) personal qualities that you will bring to your team:

 

1.  _________________________________________________________

 

2.  _________________________________________________________

 

3.  _________________________________________________________

 

 

 

I authorize the coach(es) and/or team managers to secure medical advice/attention as may be deemed necessary for the health and safety of the above-named skater. I agree to accept financial responsibility in excess of the benefits allowed by Ontario Health.

 

I hereby release, from any and all claims, the Newmarket Skating Club & Iced Energy, it directors, employees and coaches and agree that none them shall be held responsible for any accident, injury or loss, however caused, whether on or off Club premises, ice or other facilities. 

 

 

Dated at Newmarket, this ________ day of ________________, 2017

 

 

 

_________________________________           ___________________________________ 

Skater’s signature                                                    Parent/Guardian signature

                                                                                         (if skater is under 18 years of age)