2009/2010 REGISTRATION FORM

Skate Canada # ______________________   Badge Completed/Skating ability:_________________

Last Name:   _____________________  First Name:_________________  Male:____  Female: _____

Address:       __________________________ Apt/Unit # _________      Date of Birth:___________

City & Prov.: __________________________ Postal Code: ________________________________

Home Phone:         ___________________________         Business Phone:_____________________________

e-mail address:       _________________________________________________________________

Parents Names:       _________________________________________________________________

 **Family Discount applies to 3^rd and subsequent registration within one family (living at the same address).

Mittens and CSA approved hockey helmets with face shield are required and mandatory for children under 12 years old.

Payment required, in full, at time of registration, cash or personal cheque only.  NSF cheques are subject to a $30 service charge. Membership is not transferable or refundable.  Any member whose account is past due will not be permitted to try any tests or enter any competitions.  Cheque payable to "Pine Point Figure Skating Club".

The Pine Point Figure Skating Club may photograph or videotape activities during Club sponsored events.  The Club may use the Skater's name, picture or likeness in connection with any advertising or publicity feature designated by the Club, including the Club's website.  The skater and their family waives all rights to remuneration or otherwise in connection with the above.  The Pine Point FSC shall not in any way be held responsible for loss of property, damage or injuries to any person, including members.

The Club reserves the right to change the schedule, pre-empt sessions for Test Days, Competitions or cancel sessions due to insufficient registration.

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Signature of Parent/Guardian                                                                Date