Learn-to-skate Registration Form – Greater Kalamazoo Skating Association

Learn-to-skate Registration Form

SUMMER I SESSION - TUESDAY (Wings West) June 4 - 25, 2024 6:10-7:10pm 4 weeks $ 85.00 + $17** **A one time registration fee of $17.00 is required per skater per skating season (July 1, 2023–June 30, 2024). ABOUT THE CLASSES : Classes are offered for ages 3 years and up. Fees include: class time, skate rental, award patches (an award patch is given when level is completed, please note: it may take 1 or more sessions to complete a level), Learn to Skate USA membership, skills book, and Learn to Skate USA magazine. Class structure: ½ hour instruction, ½ hour supervised practice Parents may skate with their son/daughter during the supervised practice time if they pre-purchase a parent pass with their skaters registration. The parent pass is non-transferable and for a parent or guardian over the age of 18 only. Cost is $17 per session and includes skate rental. Please arrive 20 minutes prior to class the first night. Skaters should dress warmly, with mittens or gloves. Helmets are strongly recommended for beginning level skaters. Stick handling class is offered in addition to regular hockey classes to provide skaters with a full hour of instruction. Must be enrolled in Hockey 1 or higher. Required equipment: Stick, gloves, and helmet. Tuesday only, numbers permitting. Cancellation policy: If classes are cancelled due to weather, you will be notified via email. Classes are only cancelled if Wings closes the buildings. No refunds or make ups will be given. If a COVID-19 positive test occurs, credit may be given for a future session at the discretion of the Board of Directors. All registrations must be pre-registered through the website and paid in full using the PayPal link. No walk-in registrations will be accepted.

Skater Name: *

First

Skater Name: *

Last

Email: *

Phone: *

Address: *

Address Line 1

Address Line 2

City: *

State: *

Zip: *

Date of Birth: *

Age: *

Gender *

Emergency contact: *

First

Last

Phone: *

Interested in hockey:

Level registering for: *

Registration Fee:

Registration Fee - $17.00

A one time registration fee of $17 is required per skater per skating season (July 1, 2023 - June 30, 2024).

Registering For: *

Summer I Tuesday 6:10-7:10pm - $85.00
Summer I Stick handling - $35.00

Parent Pass:

Parent Pass - $17.00

Non-transferrable, must be 18 years or older

Coupon

Total Amount

$0.00

Payment Method *

Waiver and Release of Liability and Assumption of Risk Agreement *

I have read this agreement and fully understand its terms.

In consideration of participating in the Greater Kalamazoo Skating Association’s (GKSA) Learn to Skate program, and GKSA sponsored activities, I represent that I understand the nature of figure skating
activities (“activity”) and that I am qualified, in good health and in proper physical condition to
participate in such “activity.” I acknowledge that if I believe event conditions are unsafe, I will
immediately discontinue participation in the “activity.”
I fully understand that this “activity” involves risks of serious bodily injury which may be caused by my
own actions or inactions, those of others participating in the “activity,” the conditions in which the
“activity” takes place, or the negligence of the “releasees” named below, and that there may be other risks
either not known to me or not readily foreseeable at this time. I fully accept and assume all such risks and
all responsibility for losses, costs and damages I incur as a result of my participation in the “activity.”
I hereby release, discharge and covenant not to sue the Greater Kalamazoo Skating Association, United
States Figure Skating, its directors, officers, administrators, sponsors, volunteers, agents, employees, staff,
instructors, trainers, other participants, and, if applicable, owners and lessors of premises on which the
“activity” takes place (each considered one of the “releasees” herein) from all liability, claims, demands,
losses, or damages on my account, caused or alleged to be caused in whole or in part, by the negligence of
the “releasees” or otherwise, including negligent rescue operations. I further agree that if, despite this
release, waiver of liability, and assumption of risk, I, or anyone on my behalf, makes a claim against any
of the “releasees,” I will indemnify, save, and hold harmless, each of the “releasees” from any loss,
liability, damage, or cost which may incur as the result of such claim.

Consent for Medical Attention or Treatment *

I have read this agreement and fully understand its terms.

I hereby authorize the Greater Kalamazoo Skating Association,
their Board of Directors and volunteers to obtain medical care, at the expense of the undersigned, from
any licensed physician, hospital or clinic, including transportation and emergency medical services, for
myself/ourselves and/or said participant for any injury that could arise from participation in these
activities. This Consent for Medical Attention shall be binding and effective for the 2023-2024
skating year (July 1, 2023-June 30, 2024).

Name and Likeness Consent *

I have read this agreement and fully understand its terms.

By participating in a Greater Kalamazoo Skating Association ("GKSA") sanctioned event and/or hosted activity, and for good and valuable consideration, I release and grant to GKSA, including its subsidiary and affiliated entities, the right to use my name, likeness, image, photograph, voice, video, athletic performance, biographical information and any other indicia of identity, in any format whatsoever, from the event or activity listed above (collectively, my "Identifications"), and to distribute, broadcast and exhibit my Identifications, without charge, restriction or liability, in any media now known or hearafter devised (including, but not limited to, television, internet, web casting, and video streaming) or in various publications (including, but not limited to GKSA website, bulletin boards and marketing materials) into perpetuity, unless otherwise specified and agreed upon. I understand that I will not receive and compensation for any such use of my Identifications. It is also agreed that at no time can GKSA release or authorize the use of my Identifications to an unrelated third party for the purpose of my endorsement of any commercial property, product of service, without my written permission.

Concussion Information Sheet *

I have read this fact sheet for parents on concussion with my child or teen, and talked about what to do if they have a concussion or other serious brain injury.

Signature

Clear Signature

Layout

Parent Pass waiver *

I have read this agreement and fully understand its terms.

In consideration of participating in the Greater Kalamazoo Skating Association’s Learn to Skate (basic skills) program, and GKSA sponsored activities, I represent that I understand the nature of figure skating activities (“activity”) and that I
am qualified, in good health and in proper physical condition to participate in such “activity.” I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the “activity.” I fully understand that this “activity” involves risks of serious bodily injury which may be caused by my own actions or inactions, those of others
participating in the “activity,” the conditions in which the “activity” takes place, or the negligence of the “releasees” named below, and that there may be other risks either not known to me or not readily foreseeable at this time. I fully accept and assume all such risks and all responsibility for losses, costs and damages I incur as a result of my participation in the “activity.” I hereby release, discharge and covenant not to sue the Greater Kalamazoo Skating Association, United
States Figure Skating, its directors, officers, administrators, sponsors, volunteers, agents, employees, staff, instructors, trainers, other participants, and, if applicable, owners and lessors of premises on which the “activity” takes place (each considered one of the “releasees” herein) from all liability, claims, demands, losses, or damages on my account, caused or alleged to be caused in whole or in part, by the negligence of the “releasees” or otherwise, including negligent rescue operations. I further agree that if, despite this release, waiver of liability, and assumption of risk, I, or anyone on my
behalf, makes a claim against any of the "releasees,” I will indemnify, save, and hold harmless, each of the “releasees” from any loss, liability, damage, or cost which may incur as the result of such claim.

I hereby authorize the Greater Kalamazoo Skating Association, their Board of Directors and volunteers to obtain medical care, at the expense of the undersigned, from any licensed physician, hospital or clinic, including transportation and emergency medical services, for myself/ourselves and/or said participant for any injury that could arise from participation in these activities.