CARBERRY SKATING CLUB REGISTRATION FORM

Beginner Synchro. & Rising Star

Skaters Name: ______________________________M F Member #:___________________

Parent Name(s):_______________________________ ________________________________
Email: _________________________________ Birth Date: (mm/dd/yy)____/____/____
Home Phone: _______________________________ Alt Phone: __________________________
Address: ______________________________________________________________
Would you agree to allow photos of your child to be used by the Club (published in the
News Express or our Facebook page)? Yes No Signature _______________________

Beginner SynchroStartsTues. Oct.3rd

Tuesday $150

**CSC policy requires all Synchro skaters to also register for Rising Star/STARskate

Rising Star Group Program Starts Tues. Oct. 3rd and Thurs. Oct. 5th
Skating lessons include Skills, Dance, and Freeskate (1 hr. of coaching included)

Tuesday $250

Thursday $250

Tuesday and Thursday $400

Sub-Total
================
Skate Canada Fee (if not previously paid) (Non-Refundable) $35.70
Fundraising Payout (Optional) $75.00

Amount Payable October 1/17 (1/2 of Sub-Total + $35.70)Cash or Cheque

Amount Payable December 31/17 (1/2 of Sub-Total) Cash or Cheque

*Carberry Skating Club is not responsible for damage, injury, or loss.