""WICHITA CAROL FOX ICE DANCE AND FIELD MOVES CLINIC REGISTRATION FORM ""
Advanced reservations would be appreciated. Please, make checks payable to the Wichita FSC. Mail registrations to - Robert Boroughs 1926 Keith Ct., Wichita, Ks 67212. All Sales taxes are included. |
Name:___________________________________________________________________________ The undersigned agrees to
hold harmless Robert Boroughs, the United States Figure Skating, the Wichita Figure Skating Club
and all of its officers, board members, volunteers and agents and the
Wichita Ice Center, its owners, employees and agents, and the City of
Wichita, its employees and agents, from any loss, damage and/or injury that
may be sustained in any manner by the applicant while participating in any
activities of the Wichita Ice Dance Weekend. In case of injury, I hereby
authorize first-aid treatment for the applicant while participating in said
dance weekend.
Address:__________________________________________________________________________
City:_____________________________State:____________________________Zip:____________
Daytime Phone:______________________________________________________
Evening Phone:______________________________________________________
Email:______________________________________________________________
Skating level you are comfortable at:______________________________________
Pro affiliation:______________________________________________________
*OR*
Full weekend
........................................................................
$100.00
__________
Saturday First Session
.............................................................
$50.00
__________
Saturday Second Session
....................................................
$50.00
__________
Saturday Third Session
.................................................
$50.00
__________
Sunday First Session
......................................................
$50.00
__________
Sunday Second Session
........................................................
$50.00
__________
Total
.........................................................................................
$
__________
_______________________________________________
______________
Skater's Signature
Date
(parent or guardian
if skater is under 18 years of age)