| Registration Form |
Skaters Name:____________________________________________________________ Parent/Guardian Name:_____________________________________________________ Address:________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Phone #_________________________________________________________________ Date of Birth:_____________________________________________________________ Health Card #____________________________________________________________ Male______________________________Female_______________________________ Medical Conditions (if any)_________________________________________________ _______________________________________________________________________ Skate Canada #__________________________________________________________ Coaches Name:__________________________________________________________ Phone:_________________________________________________________________ Home Club:_____________________________________Number:_________________ |
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| Option Number: ____ Level:__________ Price+ gst. x #of wks:________________ Please check of the of weeks required: (ie: Week 1 begins July 5-9) ______wk1 ______wk2 ______wk3 ______wk4 ______wk5 ______wk6 ______wk7 **CASH OR CHEQUES MUST BE INCLUDED WITH APPLICATION** Conditions: 1) The applicant agrees that the Durham Region Skating Academy and/or it’s coaches will not be held responsible for any loss or accident, however caused. 2) D.R.S.A. will not be held responsible for loss of ice beyond our control. Payment: 1) All fees are payable by cash or cheque and must accompany this form which should be received no later than Fri. June 11th, 2004. Full memberships (5 days a week/7 weeks) paid in full by June 11th, 2004, will receive a 10% discount. 2) Cheques are made payable to the Durham Region Skating Academy, either in full, or 50% or more of the total amount owing. The first cheque for at least 50% to be dated on or before June 11th, 2004, the balance can be paid in 2 cheques dated July 5th, & July 23rd, 2004 COMPLETED FORMS MAY BE GIVEN TO, OR MAILED TO: D.R.S.A., Tracy Tutton, 5 Found Crt., Courtice, Ont., L1E 2V2 SIGNATURE OF PARENT/GUARDIAN:________________________________________ |