2018 SPRING CANSKATE REGISTRATION
Wednesday, April 4thto Wednesday, May 30th - THAMES CAMPUS ARENA
Home Club: ______
F or MDD/MM/YYYY
NameSexBirth Date
AddressCityProvincePostal
Phone (Home)Phone (Cell)CoachSkate Canada #
Parent/Guardian NameEmail
Description / Day / Duration / Time / Amount / PayablePre-CanSkate / Monday (1) / 7 Weeks x 30 Min / 6:00 to 6:30pm / $71.00
Monday (2) / 7 Weeks x 30 Min / 6:30 to 7:00pm / $71.00
Wednesday (1) / 9 Weeks x 30 Min / 6:00 to 6:30pm / $91.00
Wednesday (2) / 9 Weeks x 30 Min / 6:30 to 7:00pm / $91.00
Skate Canada Fee (if required) (Valid Sep1/17 to Aug 31/18) / $40.00 / $40.00
TOTAL PAYABLE / $
Description / Day / Duration / Time / Amount / Payable
CanSkate
Stages 1 - 6 / Monday / 7 Weeks x 1 Hour / 6:00 to 7:00pm / $108.00
Wednesday / 9 Weeks x 1 Hour / 6:00 to 7:00pm / $138.00
Skate Canada Fee (if required) (Valid Sep1/17 to Aug31/18) / $40.00 / $40.00
TOTAL PAYABLE / $
All Canskate participants up to and including Stage 5 MUST WEAR A CSA APPROVED HOCKEY HELMET at all times while on the ice. Please initial here that you accept this responsibility and will ensure your child complies.
Full Payment via CASH or CHEQUE is due at time of registration. There is a $15 NSF Fee for any returned cheques.
Refunds will only be allowed within 2 weeks of first skated session except for medical reasons. (A doctor’s note will be required for medical reasons.) The Skate Canada fee is Non-Refundable. THIS IS YOUR OFFICIAL RECEIPT. (No further receipts will be issued.)
Notice of Collection Statement: Your privacy and the protection of your personal information is important to us. Your personal information is required to register you with Skate Canada in any capacity, including, without limitation, as a Skate Canada registrant, coach or in connection with your affiliation with a skating club or skating school and to administer various services, such as Skate Canada events. Your personal information may also be exchanged with Skate Canada affiliates which includes your local skating club or skating school or provincial association or section. By submitting this form, you expressly provide your consent to the sharing of your personal information with Skate Canada and as described herein for purposes of registration and receipt of national services delivered by Skate Canada. We adopt the 10 Fair Information Principles into our privacy program, and employ reasonable measures to protect against unauthorized access, processing, disclosure, alteration, destruction or loss of your personal information. See Skate Canada's Privacy Policy ( for more details. For further information or comments regarding our protection of your privacy, please contact Skate Canada .
The Applicant agrees that the Chatham Skating Club and/or its proprietors and coaches will not be held responsible for any loss, however caused, and agrees to the release of the proprietors and/or coaches from all claims or damages which may arise as a result of or by reason of such injuries or loss of any nature whatsoever. If any injury takes place while on the ice, please notify someone in charge at the time, so an incident report can be filed, and if necessary, a claim can be sent to our insurance provider.
Signature of Parent of GuardianDate
CLUB USE ONLY:
Payment Method (circle one) –CASHCHQ # ______AFKAmount - ______
Date Received -______Received By - ______