Saranac Lake Figure Skating Academy
Go For the Gold Summer Skating Program
Registration Form
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Skater's name: ____________________ Level: 6 7 8 SS Age:___
Parent's name: __________________________Phone: ___________
Address: ___________________City: ___________State/zip:______
e-mail:___________________________________________________
Program Fee $225 per skater + US Figure Skating Dues
(USFS Dues $40)
That's only $15/hr per skater and includes ice time
and professional instruction
5 weeks: July 13 through August 20 (No ice 1st week of August)
5:30 to 7pm
Lake Placid Olympic Center USA Rink
5:30-6:30 - Stroking, Edges, etc.
6:30-7:00 - small group lessons, free skate
Registration on site Tuesday July 13 before/during class
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PARENTAL CONSENT AND INDEMNIFICATION AGREEMENT
hereby release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS
each of the Releasees from all liability, claims, demands, losses, or damages on the minor’s HARMLESS each of
the Releasees from all liability, claims, demands, losses, or damages on the minor’s account caused or alleged
to have been caused in whole or in part by the negligence of the Releasees or otherwise, including negligent
rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf
makes a claims against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of
the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any Releasees may incur
as the result of any such claim.
damage, or cost any Releasees may incur as the result of any such claim.
Skater's Name:________________________________________ Date: _______________
Printed Name of Parent/Guardian: ______________________________
Signature of Parent/Guardian: _________________________________
Official Use Only: date: __________
Total Paid: ________________
cash: _______ Check: #_______ Balance due: $______________