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 #)




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)