ICE WORKS Skating Academy

Location : St. Michaels College School Arena

2016 Registration Form

Skater Registration
Name

Age

Parent/Guardian
Address

Shirt Size
Street
City
Postal Code

Phone #

Mobile
Home

Email

Skater Information
Badge Level
Check ()

Preliminary

Junior Bronze

Senior Bronze

Junior Silver

Senior Silver

Gold

Skills

Free Skating

Dance

Competitive Level
Check ()

Pre-Juvenile

Juvenile

Pre-Novice

Novice

Junior

Senior

AA

AAA

Test Level
Check ()

Hockey/Skating Experience

Power Skating

Check ()

No/Minimal
Skating

House/Local
League

Select/
AE/MD

Other (Please describe)

Home Club

Use of Image
Photographs and videos may be taken during various camp activities. As the Parent/Guardian of the above named skater, ICE
WORKS Skating Academy is hereby authorized the appropriate use of still photographs and video images of the skater for the
purposes of, including but not limited to: electronic publications, print publications and websites. I give this consent with no claim
for payment.
Yes

No

Check () All weeks that skater is registering for

Week 1
(Jul 4-8)

Week 2
Week 3
Week 4
Week 5
Week 6
(Jul 11-15) (Jul 18-22) (Jul 25-29) (Aug 1-5) (Aug 8-12)

# of Weeks

Total

Mini Camp

___ x $300/wk

Regular Camp

___ x $625/wk

Competition Camp

___ x $700/wk

(A) Sub-total

Off-ice Training

Option for Mini Campers (included in Regular and Competitive Camps) ___ x $50/wk

$10 per hour ___ hrs x $10

Pre/Post Camp Supervision

9-11am &/or 5-6pm

(B) Sub-total

Deposit of $200 required by April 11, 2016 to guarantee spot for summer.
OR
Early Bird Discount - Less $15/Mini Camp week, $25/Regular Camp week, $30/
Competitive Camp when paying in FULL prior to April 11, 2016

(LESS)

NOTE - No refunds except for medical reasons. No make-up classes. Payment accepted by
cheque (Payable to ICE WORKS Skating Academy) or cash only.

$
Balance

Skaters Release
I/We, the undersigned, hereby acknowledge that certain risks of injury are inherent to participation in figure skating, power skating, and/
or recreational activities. These types of injuries may be minor or serious and may result from ones own actions or inactions of other, or
a combination of the foregoing. I/We hereby warrant being physically fit to participate in the above activity or activities and understand
that the choice to participate being with it the assumption of those risks and results which are part of the activity or activities. I/We
hereby release, hold harmless and forever discharge ICE WORKS Skating Academy and their respective staff, coaches and assistants
from any and all actions, causes of action, claims and demand for damages, indemnity, costs, interest, loss or injury of every nature and
kind whatsoever and howsoever which I/we have had, may have now or may hereafter have in anyway arising from my/our child in
connection with any such activity or activities. I/We declare having read and understood the above informed consent agreement in its
entirety and hereby consent to participate, acknowledging and agreeing to all the foregoing.

Signature of Parent/Guardian

Date

Mail completed registrations and payments made payable to:

ICE WORKS Skating Academy,
c/o Teri-Lynn Black-Calleri
16 Horsetail St.,
Markham, Ontario, L6B 1K3

ICE WORKS Skating Academy

Web - www.iceworksskating.com Email - janis.coyle@yahoo.com or tsscalleri@rogers.com
Phone - 416-733-3284 or 416-476-8896