CARBERRY SKATING CLUB REGISTRATION FORM

PowerSkate

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
______________________

November 2nd-30th + Jan. 11th -Feb 8th , 2017/18 (10

sessions)

6:45pm 7:30pm $125.00

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Skate Canada Fee (if not previously paid)(Non-Refundable)
$35.70

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Fees must be paid in full prior to first session Cash or Cheque

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

Full hockey equipment and sticks required. No pucks.