Oromocto Skating Club

Oromocto Skating Club 2010 Spring Registration – Additional Ice Time Tri-County Complex, Fredericton Junction Dates and Times Monday 7:30 – 8:30 PM Tuesday 6:00 – 7:00 PM April 5, 12, 19, 26 April 6, 13, 20, 27

Skater's Name______

Sex: M____F____ Date of Birth (m/d/y) ______/_____ /______

Address______

City______Province______Postal Code______

Parents/Legal Guardian Name______

Phone Number______E-Mail ______

Medicare Number______Medical Information ______

New Member: yes____ no____ Skate Canada Number ______

Highest Stage Passed ______Previous Club______

THE OROMOCTO SKATING CLUB WILL NOT BE RESPONSIBLE FOR ANY INJURIES SUSTAINED WHILE PARTICIPATING IN CLUB ACTIVITIES.

Signature______Print______Date______Applicant’s signature or parent/guardian’s signature if applicant is under 18 years of age

REGISTRATION FEE Intermediate/Senior………………………………….$150.00 $ ______

Please note that Spring Registration Fee is for ice time only. Skaters are responsible to bring their own coach.

Payment must be made in full. Please make cheques payable to the Oromocto Skating Club. All NSF cheques will be subject to a $25.00 charge. Oromocto Skating Club reserves the right to cancel the program if sufficient registration numbers are not obtained.

Cash/Chq # Date Amount Paid

Receipt Number ______