Friday, September 9, 2011

Registration form

Registration Form _ 2011/2012

Name:__________________________________________________ Phone:________________
Birthdate:_____________________ Hospitalization No.:_________________________________
Address: Box_________ Town:__________________________ Postal Code_________________
E-mail address:__________________________________________________________

I understand that all skaters must become a member of the Lumsden Sports Association Inc.
I further understand that Lumsden Skating Club fees are payable at the time of registration. These fees may be paid in full on the day of registration (cash or cheque), or by post-dated cheques, payable the first of each month, up to and including March 1st, 2012. Cheques are payable to the Lumsden Skating Club.
The Lumsden Skating Club, their professionals and staff, the Lumsden Sports Association Inc. and the Town of Lumsden shall not be responsible for any damages, injury, or loss of property to any member of the club, or guest, or visitors taken to the club premises, regardless of the reason or nature of such damage, loss or injury; and further, every member, guest or visitor shall use the club premises and facilities at this or her own risk.


_______________________________________ Parent Signature

Names of Parents:_______________________________________________________________
Child’s Skate Canada Number :____________________________________________________

Session starts on October 13th, 2011 - Dec. 19, 2011 & Jan. 9 – March 22, 2012

Session1 (2 times per week Mondays/Thursdays) 6:15-7:00 $375.00 $___________

Session1 (onces per week Monday or Thursday) 6:15-7:00 $200.00 $___________

Skate Canada fee payable once a year per skater (insurance and SkateCanada registration) $35.00
Total $___________

Fundraising: Moms Pantry & tupperware : $300.00 for one child, $350.00 for two children or more children
Payable by post-dated cheque (Dec.1st, 2011) at time of registration
*if you meet fundraising requirements your cheque will be destroyed *


Payment received:Cash_____________ Cheque ___________ or

postdadted cheques__________
ch #s______________________________________________

Fundraising payout/postdated cheque_______________
ch #__________________________

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