| Registration Form |
Name (Skater):_________________________________Name Parent/Guardian________________________ Address:_______________________________________________Phone#:___________________________ Male___________Female__________________Date of Birth______________________________________ Health Card Number:______________________________Medicial Conditions if any___________________ Emergency Contact Number:________________________________________________________________ Skaters CFSA#___________________________________________________________________________ Name of Coach:_______________________________________Phone#_____________________________ Home Club:________________________________________Club #________________________________ |
| 10% discount for full members ( 5 days a week/7 weeks) If paid in full by June 13, 2003. If not paid in full by June 13th, two or three cheques may accompany form. First cheque to be dated June 13, 2003 and Second Cheque must be dated no later than July 1, 2003, and the Third Cheque ( if necessary) dated no later than July 18th, 2003. |
| ALL CHEQUES MUST ACCOMPANY FORM |
| Please find enclosed a cheque in the amount of $____________________ which is 50% or more of the Membership fee. Balance payable on or before July 9, 2002. The applicant agrees that the Durham Region Skating Academy and/or its proprietors and coached will not be held responsible for any accident or loss, however caused, and also agrees to release the aformentioned from all claims and/or damages which may arise from any such accident or loss. |
| Signature of Parent or Guardian_______________________________________Date___________________ |
| Partial Memberships are available at a premium, if space permits and must be negotiated by D.R.S.A. Partial Memberships and Guest Skating : $20.00 for one on ice session, $25.00 for one on ice and one off ice session, $35.00 for 2 on ice sessions and one off ice session. Call Tracy Tutton for further information (905) 434-7895, send to Tracy Tutton, 5 Found Court, Courtice, Ontario L1E 2V2 |
| High Competitive INCLUDES: (5days / week) -10 Freeskates, 3 Spins, 2 Power Stroking, 2 Edge Classes, 1 Creative Movement, 3 Strength Training and Conditioning, 2 Pilates, 1 Off Ice Jump/Spin and 2 Patchs per week. (17 hrs, 5mins per week) $150.00 per Week _________x # of weeks $________ Sub Total $________+ GST (7%) $________Total Please check off weeks required: ___1___2___3___4___5___6___7 125 150 150 150 150 125 150 |
| Low Competitive INCLUDES: (5days / week) -10 Freeskates, 3 Skills, 2 Dance, 2 Power Stroking, 2 Edge Classes, 1 Creative Movement, 3 Strength Training and Conditioning, 2 Pilates, 1 Off Ice Jump/Spin and 2 Patches per week. (16 hrs, 50mins per week) $145.00 per Week _________x # of weeks $________ Sub Total $________+ GST (7%) $________Total Please check off weeks required: ___1___2___3___4___5___6___7 120 145 145 145 145 120 145 |
| Low Test ( Mon/Wed/Fri) INCLUDES: -3 Freeskates, 3 Off Ice Classes per week. (4hrs, 30mins per week) $60.00 per Week _________x # of weeks $________ Sub Total $________+ GST (7%) $________Total Please check off weeks required: ___1___2___3___4___5___6___7 40 60 60 60 60 40 60 |
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| Application Form |
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| Senior "A" Freeskate ONLY Membership (3 days/wk) $_______=GST(7%) Please circle # of weeks $_______Total ___4wks___6wks___7wks (Mon/Wed/Fri) 140 210 245 |
| Senior "A" Freeskate ONLY Membership (2 days/wk) $_______=GST(7%) Please circle # of weeks $_______Total ___4wks___6wks___7wks (Tues/Thurs) 100 150 165 |
| Senior "B" Freeskate ONLY Membership (3 days/wk) $_______=GST(7%) Please circle # of weeks $_______Total ___4wks___6wks___7wks (Mon/Wed/Fri) 140 210 245 |
| Senior "B" Freeskate ONLY Membership (2 days/wk) $_______=GST(7%) Please circle # of weeks $_______Total ___4wks___6wks___7wks (Tues/Thurs) 100 150 165 |
| For Senior "A" Please check Weeks Required Time of FreeSkate ___1___2___3___4___5___6___7 _________ |
| For Senior "B" Please check Weeks Required Time of FreeSkate ___1___2___3___4___5___6___7 _________ |
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