Drop-in Registration Form

Skater Details
First name  Last name 
GenderMale/Female Date of birth 
Citizenship  SSC number 
Mailing address
Street 
Town  Province 
Postal code 
Phone numbers
Home  Other 
Email address 
Medical Information
Doctor's Name  Doctor's Phone 
Health No.  Blood Type 
Parents/Guardians Details
(if member is 18 years of age or younger)
Names 
Home  Work 
Cell  Other 
Pre-requisites
Drop-in rate[  ] $ 10 each session Drop-in excl skates[  ] $ 5 each session
Equipment
(please tick to confirm the skater has all the following equipment)
[  ] Neck guard     [  ] Helmet     [  ] Cut resistant gloves     [  ] Knee pads
Declaration
Session Fee$ Received by

In consideration of your accepting this registration, I hereby, for myself, my heirs, executors, administrators and assigns, waive and release any and all rights and claims for damages I may have against Speed Skating Canada and the Alberta Amateur Speed Skating Association and its member clubs, their agents, officers or members, the Banff/Canmore Speed Skating Club and the Town of Canmore, for any injuries suffered by the member while traveling to or from or participating in skating practices, competitions, or other activities, nor shall they be responsible for any damages or losses caused by the member during the same time. In signing this release I acknowledge the potential for injury.

The Supervisor on duty has my permission to take me or my child for medical attention if they consider it necessary. Registration will be accepted only under such condition.

 
Signature Date of signature
(signature of adult skater, parent or guardian)
How did you hear about us ?