Last Name / First Name
Age as of July 1, 2014 / Club
Sex (M or F) / 1500 m time (on 111m track)
500 m time (on 111m track) / Health Card #
400 m time / Special Needs
Severe allergies
(food or medication) / T-Shirt Size: S, M, L orXL
Indicate: Youth, Adult or Ladies
PARENTS INFORMATION
Mother’s Name / Home phone
Father’s Name / Mother’s cell #
Father’s cell # / Mother’s work #
Father’s work # / Contact Email
Alternate Emergency Contact / Alternate Emergency Contact #
Mailing address
Street, City, Postal Code
CAMP REGISTRATION / Groups 1 & 2 / Group 3&4 / Please check
what you sign up for
Technical Camp Toronto
- Full 2 weeks July 14-18 & July 21-25 / $700 / $560 / ☐
- Week 1 only July 14-18 / $375 / $300 / ☐
- Week 2 only July 21-25 / $375 / $300 / ☐
Conditioning Camp Cambridge Aug. 14-18 / $375 / $300 / ☐
Interested in:
- Transportation option / Approx. $100 / week, TBD / ☐
- Billeting / $150 per week / ☐
Note that registrations will be accepted on a first come basis. However, priority will be given to skaters registering for the whole camp (all 3 weeks). Registration opens on March 3, 2014.
DEPOSIT A non-refundable deposit cheque of $250 is required with registration. Registrations not accompanied with the deposit will not be considered received. In the event that the camp is full, your deposit will be returned by mail.
CONFIRMATION OF REGISTRATION You will be notified via email when your registration is received. Registrations will be confirmed by May 1st. In the week of June 2nd, you will be notified of your group and of the balance owed, which is due no later than June 13th. Failure to receive your full payment by this date may result in loosing your spot at the camp.
Please send your form and payments (deposit and later balance owed – for both the Toronto and Cambridge portions of the camp) to TSSC, 20 Joseph Duggan Road, Toronto, Ontario, M4L 3Y2. Please make your cheques payable to TSSC.
CANCELLATION POLICY Full refunds will be granted to skaters withdrawing from the camp for medical reasons (a doctor’s note is required), at any time. Withdrawals after June 13th:50% refund. Withdrawals within 2 weeks of the camp are not refundable.
WAIVER 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, the Ontario Speed Skating Association, the Toronto Speed Skating Club, the Cambridge Speed Skating Club, the City of Toronto, the City of Cambridge, their agents, directors, officers or members, for any and all injuries suffered by me during the Summer Camp 2014. I hereby give the Toronto and Cambridge Speed Skating Clubs permission to post pictures, videos and event results of my child / myself on the clubs website, to the clubs’ arenas, in the local newspapers and on photo and video sharing websites.
Print Name(Parent or Guardian if under 18):Authorizing Signature (Parent or Guardian if under 18):
Date