CARBERRY SKATING CLUB REGISTRATION FORM

STARSkate Levels 1&2 STARSkate Levels 3+

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 _______________________

STARSkate Levels 1 & 2 Private Lessons Starts Tues. Oct. 3 rd and Thurs.
Oct. 5th
Tuesday STARSkate 1&2
$150
STEELE, Skating Skills/Dance,
Freeskate (1h 15min/wk)

Thursday STARSkate 1&2

$125
STEELE, Skating Skills/Dance,
Freeskate (1h /wk)

Tuesday and Thursday $225

STARSkate Levels 3+ Private Lessons Starts Tues. Oct. 3rd and Thurs.
Oct. 5th
Tuesday STARSkate 3+
$200
STEELE, Skating Skills/Dance,
Freeskate (1h 30min/wk)

Thursday STARSkate 3+
$225
STEELE, Skating Skills/Dance,
Freeskate (1h 45min/wk)

Tuesday and Thursday $350

ICE TIME COSTS ONLY THE STARSkate PROGRAM DOES NOT INCLUDE COACHING FEES

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.