2015- 2016 Wainfleet SC Mid Season Registration
Wainfleet Skating Club - A Member of Skate Canada
P.O. BOX 57, WAINFLEET, ON L0S 1V0
January 2, 2016 to April 14th, 2016
Last Name:
Skate Canada#
DOB: (D/M/Y)
Address:
Postal Code:
Email Address:
First Name:
Home Club ( if not WSC):
Male:
Female:
Town/City:
Telephone:
Cell#:
***Please check appropriate sessions***
Program
1 Day
2 Day
3 Day
Total
Canskate (M, S,)
125.00
175.00
N/A
Primary
140.00
200.00
N/A
Minus 2nd Child Discount 10% (avail to 2nd highest registration value)
Minus 3rd Child Discount 15% (avail to 3rd highest registration value)
Minus 4th Child Discount 20% (avail to 4th highest registration value)
Dance/Skill (M,T,S)
45.00
80.00
N/A
Power/Spins
60.00
N/A
N/A
Sub Total
Minus Applicable Credit Points
Skate Canada Fee & WOS Insurance
35.00
Non Home Club Fee ($25.00 if applicable)
Total Due **all cheques must accompany form**
1st Installment due Dec 31
Cheque #:
$
2nd Installment due Jan 31
Cheque #:
$
Fundraising
due Apr 1
Cheque #:
$
25.00
A Fundraising Cheque must be attached to the registration form. When each family completes
their volunteer hour/fundraising commitment, the cheque will be destroyed.
SKATE CANADA FEE & WOS INSURANCE, IS MANDATORY FOR ALL MEMBERS.
EFFECTIVE JULY 2011- ALL SKATE CANADA MEMBERS NOT PASSED STAGE 5
CANSKATE - MUST WEAR A CSA APPROVED HOCKEY HELMET WHILE
PARTICIPATING IN A SKATING SESSION.
2/17/2016
2015-2016 Wainfleet SC Release Form
I
, consent to (skater’s name)
to participate in the activities of the Wainfleet Skating Club, and hereby release the Wainfleet Skating
Club and its agents (coaches, board members, volunteers) from all claims, any damages, injury or loss of
property to any member or visitor to the club regardless of the nature of such damage, loss or injury.
Every member or visitor shall use the club facilities at his or her own risk.
Signature of Parent/Guardian
Date
Print name
PUBLICITY WAIVER
I
give permission for my daughter/son
to be
included in photographs and or videos which may be used for publicity in local media, web site, club
bulletins, and/or newsletters of the Wainfleet Skating Club and that their full name may be used in
recognition of their participation and accomplishments at the Wainfleet SC.
Signature of Parent/Guardian
Date
HARNESS WAIVER
I
give permission for my daughter/son
to use
the harness at the Wainfleet Skating Club. In consideration of acceptance of the skater in the Wainfleet
Skating Club and acceptance of the use of the “jump harness”, I, for myself, my child, my heirs,
executors, administrators and assigns waive any claims to which I may become entitled for injury or
damage, and I hereby release the Wainfleet SC and the Township of Wainfleet, and all other organizers,
sponsors, representatives, the executives, members, their agents and employees, and any other person
or organization assisting from any claim, damage or injury that may suffered by me or my child as a result
of using the “jump harness”.
Signature of Parent/Guardian
Date
WSC REFUND POLICY
First Time New Skater: During the first 4 sessions a parent may request a refund from Wainfleet SC.
The membership fee will be reimbursed. The $35.00 Skate Canada Fee is non-refundable. The WOS
Lottery Book can only be refunded provided it is the only skater in the family, and must be returned in its
original condition, for a refund.
All other members: Fees will be refunded for a medical reason only, based on date of injury. A letter to
the Board requesting refund is required. The Skate Canada fee & Lottery Book is non-refundable.
I have read and fully understand the WSC Refund Policy and the Skate Canada Helmet Policy:
Signature:
Date:
Witnessed by Club Official:
Date:
2/17/2016