BSC Learn To Skate Registration Form

Learn To Speedskate Registration
Athlete Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Gender *

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Street shoe size *
Foot measument: to measure your foot, place a piece of paper against a wall. Stand barfoot on the paper with your heal against the wall and draw a line in front of your longest toe. Do this with both feet since one foot is somtimes bigger than the other. Measure in inches the distances from the end of the paper to the lne and enter it below.
Right Foot measurement: (heal to longest toe) *
Left Foot measurement: (heal to longest toe) *
Skating experience *
In case of emergency please contact: *
Phone Number *

Area Code Phone Number
Relationship *

Please print and fill out the form below and bring it to your first session. Thank you.

Informed Consent and Acknowledgement

I acknowledge that, as in all sports and exercise, there is an element of risk and that I am physically and medically capable of participating in skating activities. In consideration of the acceptance of my application and permission to participate in the Learn to Speedskate Program, and in any of the Buffalo Speed Skating Club events, activities, or training sessions.

I myself, my heirs, executors, administrators, successors, and assigns RELEASE, WAIVE and FOR-EVER DISCHARGE the Buffalo Speed Skating Club, it’s organizers and coaches, US Speedskating, Cazenovia Ice Rink, Cazenovia Park Youth Hockey As-sociation, Riverside Ice Rink, City of Buffalo, South Buffalo Community Association, Hasek’s Heroes, The Northtown Center, Town of Amherst and all other associations, sanctioning bodies and sponsor-ing companies, and all their respective agents, officials, servants, contractors, representatives, and assigns of and from all claims, demands, damage cots, expense, actions, and causes of action, OF ANY KIND WHATSOEVER, whether in law or equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reason of my participation in any event organized by the team, whether as a spectator, participant, competitor, or otherwise, whether prior to, during or subsequent to the event and notwithstanding the same may have been contributed to or by negligence of any of the aforesaid.

I further undertake to skate safely and wear protective equipment at all times. All skaters must wear an ANSI/SNELL certified helmet, cut resistant neck guard, knee pads and full fingered gloves.

COVID-19 Liability Waiver

I acknowledge the contagious nature of COVID-19 and that the CDC and many other public health authorities recommend practicing social distancing and other preventive measures. I further acknowledge that the Buffalo Speedskating Club (BSC) has put in place preventative measures to reduce the spread of COVID-19 during at all practices and events.

I further acknowledge that the BSC can not guarantee that I will not become infected with Covid-19. I understand that the risk of becoming exposed to and/or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to the BSC staff, coachs, skaters, the rink staff and other present individuals. I voluntarily agree to participate, and acknowledge that I am increasing my risk of exposure to COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending any practice or event.

I myself, my heirs, executors, administrators, successors, and assigns RELEASE, WAIVE and FOR-EVER DISCHARGE the Buffalo Speed Skating Club, it’s organizers and coaches, US Speedskating, Cazenovia Ice Rink, Cazenovia Park Youth Hockey Association, Riverside Ice Rink, City of Buffalo, South Buffalo Community Association, Hasek’s Heroes, The Northtown Center, Town of Amherst and all other associations, sanctioning bodies and sponsoring companies, and all their respective agents, officials, servants, contractors, representatives, and assigns of and from all claims, demands, damage cots, expense, actions, and causes of action, OF ANY KIND WHATSOEVER, whether in law or equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reason of my participation in any event organized by the team, whether as a spectator, participant, competitor, or otherwise, whether prior to, during or subsequent to the event and notwithstanding the same may have been contributed to or by negligence of any of the aforesaid.

Photography

By attending BSC paractices and events, I consent to having photos and/or videos taken of me. The photographs and/or videos may be used for the purposes of coaching, advertising, editorial or other promotional work, and for any other purpose whatsoever. They may be use in any and all media worldwide including online now or hereafter known.

I herby release to the BSC all rights to exhibit in print and electronic form publicly or privately and to market copies. I waive any rights, claims or interest I may have to control the use of my identity or likeness in the photographs and/or video and agree that any uses decribed herin may be made without compensation or additional consideration of me.
Confirmation

BY AGREEING BELOW AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT IS EQUIVALENT TO AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
*

I Agree
Parent or guardian if participant is a minor:

First Name Last Name
Contact email:
We skate at the Riverside Ice Rink on Sundays form 1:00pm to 2:20pm and on Wednesdays form 7:00pm to 7:50pm.

Please either select a date that you would like to start or choose "I do not know..."
Date you would like to start:

Month Day Year
I do not know at this time when I will begin.
How did you hear about our Learn To Skate Program? If you were referred by a BSC member please include their name.
Payment *
prev next ( X )
Registration (online payment) $ 50.00

Registration $50.00 (I will pay by check or cash at my first session) Free

Friends and Family Member Program (Please choose this option only if you were instructed to do so by a referring BSC member). Free

Total $ 0.00
Should be Empty:

Learn To Speedskate Registration