ADULT SPRING GROUP LESSONS 2016

Wednesday Evenings, 8:00 9:00 p.m.

hour Instruction, hour Practice
Rental Skates Included
Eight Week Session Offered -- $110.00
March 2nd - April 27th
No Class on Wednesday, March 23rd
Adults are permitted to join our other Group Lesson Sessions on Sundays from
4:05 to 5:05 pm for Session V (4/10 5/15). Consult
www.delawarecountyskatingclub.org for application(s).

Please send payment and completed form to:

Skatium, 1002 Darby Road, Havertown, PA 19083, Attn: Kristin Caparra
Call (610)853-2085 or E-mail kc.skatium@yahoo.com for more info.
Name ______________________________ Phone (Day) ______________ (Eve) ______________
Address _________________________________________________________________________
Age ______

Emergency Contact _____________________________ Phone __________________

Previous Lesson Experience __________________________________________ None _________

Level passed at last group lesson ____________________________________________________
IN CONSIDERATION OF THE APPLICANT BEING PERMITTED TO REGISTER AND PARTICIPATE IN SKATIUM GROUP LESSONS UNDER THE
AUSPICES OF DELAWARE COUNTY SKATING (DCSC), I/WE DO FOREVER RELEASE, INDEMNIFY, PROTECT, HOLD HARMLESS, AND
DISCHARGE SKATIUM, DCSC, TOWNSHIP OF HAVERFORD, THEIR DIRECTORS, INSTRUCTORS, AND EMPLOYEES FROM ALL MANNER
OF ACTION, INJURY, DAMAGE, COSTS, CLAIMS, OR DEMANDS WHICH MAY ARISE AS A RESULT APPLICANTS USE OF SKATIUM FOR
GROUP LESSONS. THIS RELEASE AND INDEMNITY SHALL BE BINDING ON ALL HEIRS, EXECUTORS, SUCCESSORS, ADMINISTRATORS,
AND ASSIGNS. IT IS FURTHER AGREED THAT THE SKATIUM/DCSC SHALL NOT BE CONSIDERED TO GUARANTEE OR WARRANT SUCH
EQUIPMENT AS MAY BE USED IN THE CONDUCT OF SAID GROUP LESSONS.

Participant (Skaters over 18) Signature:

_________________________________________________