Kingsgate Skating Club

Membership Application

August 1, 2009 - June 30, 2010

Skater’s name:____Birthdate:_-_-_

Parent/Guardian:______

Address:______

City/State/Zip:______Phone:______

Email address:______

Kingsgate Skating Club membership # (if you are renewing):______

Are you a current Individual USFS member?_____ Membership #:______

Membership Dues

First family member $35.00

*Second family member $30.00

*Additional family member $20.00

TOTAL enclosed $_____

* Please use one form per skater, and turn in all forms together.

Do you want the skater’s name and phone number included in the Kingsgate Skating Club directory? Please circle one: YES NO

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Kingsgate Skating Club Release of Liability:

I am aware that ice skating is a hazardous sport that includes certain dangers, including the risk of serious injury or death. I voluntarily accept full responsibility for all risks involved, including risks inherent in ice skating and I the ice arena environment.

I accept my responsibility to skate safely at all times, to abide by the safety rules of KINGSGATE SKATING CLUB and to obey all posted behavior notices and any other arena safety rules and policies. Any equipment I use while skating, I use at my own risk.

I agree to RELEASE, HOLD HARMLESS, and INDEMNIFY Kingsgate Arena, KINGSGATE SKATING CLUB, any of their employees, agents, contractors, subsidiaries, officers, coaches or owners from all claims of injury or damage resulting from any cause, including negligence which arises out of my participation in or travel associated with KINGSGATE SKATING CLUB.

If I am signing for a minor, I recognize that I may not release any claims the minor may have. However, I accept full responsibility for all medical expenses incurred as a result of the minor’s participation in KINGSGATE SKATING CLUB. I agree to HOLD HARMLESS and INDEMNIFY KINGSGATE SKATING CLUB. I also agree to HOLD HARMLESS and INDEMNIFY the participating ice arena and coaches. This release does not cover gross negligence or intentional acts.

Skater’s signature:______Date:______

Parent’s signature:______Date:______

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Make check payable to Kingsgate Skating Club ~ Mail or bring check and this form to: