WINDY HILL SKATING CLUB
A MEMBER OF USFSA
PLEASE CHECK ONE
HOME OR ASSOCIATE MEMBER
 NEW OR RENEWAL APPLICATION
JULY 1, 2012 – JUNE 30, 2013
PLEASE USE ONE FORM PER SKATER.
Skater’s Name______________________________________USFS#_______________Date of Birth:__/__/__
Home
Address_____________________________________City______________________State______Zip________
Parent(s) Names(s) _________________________________________Parents E-mail____________________
Home Phone________________________Bus Phone____________________Cell_______________________
Primary Coach______________________Coach Cell_________________Coach E-Mail __________________
Is Skater a US Citizen? Yes/ No
If an Associate Membership: Home Club__________________________
Current Test Level Passed: Freestyle______________Moves_____________Dance___________
If no tests passed, indicate skaters USFSA ‘Skate with us’ level: Basic 6 7 8 Freestyle 1 2 3 4
MEDICAL INFORMATION
Emergency Contact_______________________________________________Phone_____________________
.
Primary Physician’s Name_________________________________________Phone_____________________
Medical Coverage Insured with_____________________________________Plan #_____________________
Special Instructions/allergies/comments__________________________________________________________
WAIVER OF LIABILITY
I, the undersigned, as parent and/or legal guardian and on behalf of (minor’s name)____________________________________
a minor, do hereby agree to indemnify and hold harmless the Windy Hill Skating Club (WHSC), The Dorothy Hamill Rink,
The Town of Greenwich, United States Figure Skating and all agents, employees, officers, directors, principles, volunteers,
sponsors, staff, instructors and administrators of these organizations from any and all liability and/or damages to this skater
for any injuries or loss which may be sustained either while participating at any activity sponsored or organized, run or
sanctioned by the WHSC or for any injuries or loss as a result of this skaters participation in a WHSC activity.
I have read and agree to abide by the enclosed WHSC Rules, Subscription Ice Policy and Walk-on procedures.
Parent or Legal Guardian:____________________________________________Date:____________
Membership
Windy Hill Home Club Members
Windy Hill Associate Membership
Windy Hill Associate Membership
Subscription Member
Total Membership(S) $ Enclosed
Ice
Type
Single
Additional Family
member(s)
Single
Additional Family
member(s)
Single –must have ice
subscription
Fee
$100
$35 each
Total
$70
$35
$50
$
WINDY HILL SKATING CLUB
SUBSCIPTION ICE FORM
2012-2013 SEASON
Please complete 100% of this form, we will return all incomplete forms.
SKATER’S NAME: _________________________________________________ USFSA Number_______________
ICE SUBSCRIPTION ASSOCIATE MEMBERSHIP
Membership in WHSC is required to utilize the ice as a skater. For those skaters purchasing a subscription plan,
an Ice Subscription Associate membership is offered for $50.00. Please complete the reverse side of this form.
SUBSCRIPTION ICE RATES
Are based on annual estimated ice costs and are calculated to provide a discounted rate over the walk on ice costs.
Walk on rates will be $28.00 per hour or $50.00 for two hours paid at start of first hour session. Hourly rate will
apply to an additional hour added to first hour purchased. Walk On payment must be received before skater will
be allowed on ice – NO EXCEPTIONS. Checks should be made out to WHSC.
FULL 2 HOUR
SUBSCRIPTIONS
Session Time
Weeks
Fridays
5:15 to 7:15 pm
27 Weeks
Single
Payment 6.5%
Discount
$1050.00
Saturdays
No Ice 12/8 &3/2
ONE HOUR
SUBSCRIPTIONS
Fridays
4:15 to 6:15 pm
25 Weeks
$973.00
27 Weeks
28 Weeks
25 Weeks
25 Weeks
Single
Payment*
$600.00
$600.00
$555.00
$555.00
Saturdays
No Ice 12/8 &3/2
TOTAL
ENCLOSED
5:15 to 6:15 pm
6:15 to 7:15 pm
4:15 to 5:15 pm
5:15 to 6:15 pm
Two Payments
each
Amount Paid with
Application
$562.00
Second installment due Dec 2nd 2012
$520.00
Second installment due Dec 2nd 2012
* FULL PAYMENT REQUIRED.
ALL SUBSCRIBERS MUST BE PAID IN FULL BY DECEMBER 2, 2012; WHSC IS NOT RESPONSIBLE FOR INVOICING
SECOND PAYMENT. NO SKATER WILL BE PERMITTED TO COMPETE, EXHIBIT OR TEST UNLESS THEIR WINDY HILL ACCOUNT IS IN GOOD
STANDING. WHSC WILL REPORT ALL NON-PAYMENTS TO USFSA. CONTACT CHRIS ABBOTT, (203) 869-6728, WITH ANY PAYMENT QUESTIONS.
Please Note: there are only 26 spaces available on each session. If more than 26 skaters apply for any session some
skaters will not be awarded all of the ice time for which they apply. Ice subscriptions are awarded in the following
order for applications received by September 15, 2012:
1.
2.
3.
4.
5.
6.
7.
Skaters re-subscribing for the same session as they skated last season.
Greenwich residents, new subscribers who are home club members
Non-Greenwich residents, new subscribers who are home club members
Greenwich residents, new subscribers who are assoc members
Non-Greenwich residents, new subscribers who are assoc members
Any late applications on a first come first serve basis, space permitting.
2 hour subscriptions take precedence over 1 hour subscriptions
WALK ON ICE
For the safety of the skaters and quality of the session, the maximum number of skaters permitted on WHSC
Session Ice is 26; only WHSC Home Club and Associate members will be allowed to walk on to a session. Walk
Ons are generally on a first come, first served basis, and on a space available basis. For a sold out subscription
session, space is available when a subscribed skater is not present. A subscribed skater is considered not present if
they do not report to the ice monitor within the 1st 10 minutes of the start of the session. Walk on ‘reservations’
are not accepted. Regional, Sectional or National competitors will be given preference for walk-ons in the weeks
preceding these competitions. Walk Ons are based on a $28.00 per hour or $50.00 per 2 hour rate.
Please Mail All Membership Forms To
Carol Morris-Fox, 6 Buena Vista Drive, Greenwich, CT, 06831; email cmflitig@aol.cm