MANVERS

SKATING CLUB - 2017-2018 REGISTRATION

Surname: First Name:
Skate Canada Number: Birthdate:
Address:
Town: Postal Code:
Parent/Guardian: Telephone:
Email:
Emergency Contact: Emergency Contact Number:
List any medical conditions:

Programs (Please Circle Your Selection) Monday Thursday Both Total

Pre-CanSkate $ 110 $ 110 $ 200 $
CanSkate (Stage 1 to 5) $ 380 $ 380 $ 562 $
CanSkate (Stage 6) $ 500 $ 500 $ 700 $
StarSkate $ 500 $ 500 $ 700 $
Stage 5 Rising Star $ 50 $ 50 $ 65 $
Stage 6 & StarSkate Off-Ice (off-ice only for Monday skaters) $ 125 $
Total Program Fees (A) $

Skate Canada Fees (Mandatory fee of $35 per skater) $ 35
Club Fundraising Fee (Pre-Can $50; CanSkate / StarSkate $100)
**Maximum $150 per family $
Total Club Fees (B) $
Total Fees (A + B) $

Payment Information Method Amount
Due Now (Minimum: B + 50% of A) Cash Cheque Credit (s/c $ ) $
Balance Due December 1, 2017 Cash Cheque Credit (s/c $ ) $
The applicant agrees to abide by both the policies and Constitutions/By-Laws of the Manvers Skating Club, which is available in the music room. By
providing your e-mail address, you agree to allow the Manvers Skating Club to send you e-mail as our main form of communication.

LIABILITY WAIVER AND RELEASE

It is understood and agreed, as a condition of participation in skating offered by the Manvers Skating Club and Skate Canada, that neither the club
nor Skate Canada shall be liable for any injury, loss or damage suffered by the above noted member while traveling to or from or while
participating in skating practices, competitions or other related activities, however caused. It is further agreed that neither the Manvers Skating
Club nor Skate Canada is responsible for any injury, loss or damage caused by any member while traveling to or from or while participating in the
said practices, competitions or other related activities. The member or his/her parent/legal guardian, who signs this form, shall indemnify the club
and Skate Canada and them harmless from any claims, demands or actions arising from or in respect to such injury, loss or damage. All programs
are subject to a minimum and maximum enrolment, and subject to cancellation or changes in requirements. The cancellation policy is understood.
The club will use photos taken for our program and for our website, if you have a concern with this, please advise the Board directly.

NOTICE REGARDING THE COLLECTION OF PERSONAL INFORMATION AND PRIVACY STATEMENT
Your privacy and the protection of your personal information is important to us. Your personal information is required to register you with Skate
Canada in any capacity, including, without limitation, as a Skate Canada registrant, coach or in connection with your affiliation with a skating club or
skating school and to administer various services, such as Skate Canada events. Your personal information may also be exchanged with Skate
Canada affiliates which includes your local skating club or skating school or provincial association or section. By submitting this form, you expressly
provide your consent to the sharing of your personal information with Skate Canada and as described herein for purposes of registration and
receipt of national services delivered by Skate Canada. We adopt the 10 Fair Information Principles into our privacy program, and employ
reasonable measures to protect against unauthorized access, processing, disclosure, alteration, destruction or loss of your personal information.
See Skate Canada's Privacy Policy for more details. For further information or comments regarding our protection of your privacy, please contact
Skate Canada at safesport@skatecanada.ca.

Signature of Parent/Guardian: Date: