2017 Fall Power Plus Program

2017 FALL SKATING

POWER PLUS PROGRAM

To Register for the Program, please complete the form below and submit.

6 - 425 Hespeler Road, Suite # 322, Cambridge, ON, N1R 8J6

519-624-4532, info@skatectc.com

Skater Information:

Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

Phone Number

- Area Code Phone Number

Parents Name: *

First Name Last Name

Birth Date *

Month Day Year

Level Skater is Skating for the 2017/18 season:

Session & Fee Structure Information:

*

Tuesdays Program 6:10pm - 7:00pm $ 100.00 CAD

Thursdays Program 8:10pm - 9:00pm $ 100.00 CAD

Insurance (new season) $ 36.00 CAD

Subtotal $ 0.00 CAD Tax $ 0.00 CAD Total $ 0.00 CAD

Additional Notes:

The Fall Program is held at the Preston Auditorium.

Class dates: September 5 to October 10, 2017 (5 week program)

Limited space, register early!

All skaters are required to wear full equipment and bring stick.

Informed Consent and Acknowledgement

I, the undersigned accept full financial responsibility for this application form. I understand that there will be no refunds of deposits or due balances after the deadline dates. I agree that Huston, Wheeler & Wheeler Skating Schools (KLFSS Inc) will not be held responsible for any accidents or loss, however caused and agree to release indemnity and save harmless the Huston, Wheeler & Wheeler Skating Schools (KLFSS Inc) from all damage or claims as a result of such accidents or loss. I agree my child / ward will abide by the rules and regulations of the Champions Training Centre of Cambridge {KLFSS Inc} as set by the directors. Any disregard for these rules will result in the removal of the Skater from our skating program without refund of any fees paid.

Confirmation
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Enter the message as it's shown *