<p> 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</p><p>Skater's Name______</p><p>Sex: M____F____ Date of Birth (m/d/y) ______/_____ /______</p><p>Address______</p><p>City______Province______Postal Code______</p><p>Parents/Legal Guardian Name______</p><p>Phone Number______E-Mail ______</p><p>Medicare Number______Medical Information ______</p><p>New Member: yes____ no____ Skate Canada Number ______</p><p>Highest Stage Passed ______Previous Club______</p><p>THE OROMOCTO SKATING CLUB WILL NOT BE RESPONSIBLE FOR ANY INJURIES SUSTAINED WHILE PARTICIPATING IN CLUB ACTIVITIES.</p><p>Signature______Print______Date______Applicant’s signature or parent/guardian’s signature if applicant is under 18 years of age</p><p>REGISTRATION FEE Intermediate/Senior………………………………….$150.00 $ ______</p><p>Please note that Spring Registration Fee is for ice time only. Skaters are responsible to bring their own coach.</p><p>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.</p><p>Cash/Chq # Date Amount Paid</p><p>Receipt Number ______</p>