BSC Skating and Membership Form 2017-18 Mid-Season

Skating and Membership Registration

Mid-Season
Club Skating & Membership Fees 2018-2019

Club Membership Dues - $50.00, (tax deductible as allowed by law). All skaters (other than drop in’s) must be members of the BSC. The $50.00 per person membership dues are separate from the skating fees and must be paid in full at time of registration.

If joining after the season begins, the cost will be calculated based on the number of skating sessions left, and payment must be received in full. Skaters must also be members of US SPEEDSKATING - www.USspeedskating.org

Please note that your payment and all forms must be received before you can skate.

Riverside Ice Rink

Individual Plan

Wednesday & Sunday $500 ($300/$200)

Wednesday $200 ($120/$80)

Sunday $300.00 ($180/$120)

Family Plan (two or more skaters)

Wednesday & Sunday $900 ($500/$400)

Wednesday $360 ($216/$144)

Sunday $540 ($324/$216)

Additional day for one day skaters (1st skate free) - Wednesday - $10 / Sunday - $15

Skate Rental: $10 per full or partial month. $70 Must be paid in advance for the season. If no longer required, 10 per month will be refunded .

Learn to Skate Program - 3 sessions $50 including skates. If you join the club and skate after the program, the $50 fee will be credited towards your skating fees.

Drop in skate for unaffiliated skaters or members of other clubs - (1st skate free) Wednesday - $10 / Sunday - $15

Refund Policy: Skating and Membership fees are non-refundable. Skate rental fees are refundable for full months only.

Athlete Information
Athlete's Name *

First Name Last Name

Address *

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

Phone Number *

- Area Code Phone Number
E-mail *
Birth Date *

Month Day Year
Gender *

Male Female
USS Membership Number *
USS Membership Expiration Date *

- Month - Day Year
Date
_____________________________________________
In case of emergency please contact: *
Phone Number *

- Area Code Phone Number
Relationship *
_____________________________________________
I will be renting club skates *

Yes No
_____________________________________________
Add additional athletes in the same family *

Yes No

Additional Athlete Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Gender *

Male Female
USS Membership Number *
USS Membership Expiration Date *

- Month - Day Year
Date
I will be renting club skates *

Yes No
Add additional athletes in the same family *

Yes No

Second Additional Athlete's Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Gender *

Male Female
USS Membership Number *
USS Membership Expiration Date *

- Month - Day Year
Date
I will be renting club skates *

Yes No
Add additional athletes in the same family *

Yes No

Third Additional Athlete's Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Gender *

Male Female
USS Membership Number *
USS Membership Expiration Date *

- Month - Day Year
Date
I will be renting club skates *

Yes No

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, 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.

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 ABOVE 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 athlete(s) is a minor:

First Name Last Name
Contact email:

Code of Conduct

All members and parents of minor skaters are required to review, discuss, and accept the BSC's Code of Conduct and indicate that they have read and understand their responsibilities by signing the agreement.

Please print out the Code of Conduct and bring the signed document to your first practice.

Thank you.

______________________________________

Fees:

Ice fees after the start of the season are prorated based on the number of sessions remaining in the season.

If you participated in the Learn to Skate program the $50 fee will be credited towards your payment.

The total amount due including your skating fees, $50 membership fee and rental fees (if applicable) will be provided to you.
Payment *

USD Total
Should be Empty:

Skating and Membership Registration