LESSONS REGISTRATION FORM

PLEASE SIGN ME UP!

Please circle which class you are registering for:

1. SATURDAY BEGINNERS SKATING LESSONS ($50)

2. WEDNESDAY BEGINNERS SKATING LESSONS ($40)

NAME AGE SESSION #

___________________________

ADDRESS CITY

STATE ZIP HOME TELEPHONE WORK TELEPHONE

DATE OF BIRTH MONTH DAY YEAR

CONSENT AND LIABILITY WAIVER

THE UNDERSIGNED HAVING KNOWLEDGE OF THE PHYSICAL RISKS INVOLVED IN INSTRUCTIONAL SKATING PROGRAMS, WAIVE ANY CLAIM I (WE) MAY HAVE FOR MYSELF (OURSELVES) AND THE APPLICANT FOR ANY INJURIES SUSTAINED DURING THE COURSE OF MY INSTRUCTIONAL SKATING SESSIONS. I (WE) FURTHER RELEASE BONAVENTURE, IT’S EMPLOYEES AND AFFILIATES FROM ALL CLAIMS FOR DAMAGES OR LIABILITY RESULTING FROM APPLICANTS ACTIVITIES.

IN ADDITION, THE UNDERSIGNED HEREBY AUTHORIZES THAT IN THE EVENT OF A SUSTAINED INJURY, THE PROGRAM DIRECTOR OR HIS ASSISTANTS MAY SECURE TEMPORARY EMERGENCY CARE.

THERE ARE NO MAKE-UP CLASSES AND NO REFUNDS OR CREDITS WILL BE GIVEN FOR ANY REASON.

SIGNATURE (PARENT’S SIGNATURE IF UNDER THE AGE OF 18) DATE