2016 NBFSC Summer Registration Form

Please review our "2016 Summer session" information sheet posted on our website for details regarding session formatting and fees before completing this form.

If you encounter problems when completing this form, please contact president@nbfsc.on.ca.

Last Name: *

First Name: *

Email: *

Contact Phone: *

Date of Birth (mm/dd/yyyy): *

Skate Canada Number:

Street: *

City: *

Province: *

postal code: *

Highest Freeskate Test passed: *

Select # of each session:

	Full Session A (all 4 wks)
	Session A: wks 1- 3
	Session A - wk 4
	Daily Skating (either session)
	Full Session B (all 4 wks)
	Session B - wks 1 - 3
	Session B - wk 4

EXAMPLE:

1 Session A all 4 weeks or

1 Session A wk 1 and/or

2 Session B - wks 2-4 and/or

2 Daily sessions

and then specify in the chart, below

which specific dates you will skate.

NOTE: Session A requires that you have

completed Junior Bronze or higher

Current Total:

$0.00

Please specify which days you will skate:

*

	Full week	Monday	Tuesday	Wednesday	Thursday	Friday	N/A
Week 1 (July4-8)	Full week	Monday	Tuesday	Wednesday	Thursday	Friday	N/A
Week 2 (Jul 11-16)	Full week	Monday	Tuesday	Wednesday	Thursday	Friday	N/A
Week 3 (Jul 18-22)	Full week	Monday	Tuesday	Wednesday	Thursday	Friday	N/A
Week 4 (Jul 25-28)	Full week	Monday	Tuesday	Wednesday	Thursday	Friday	N/A

Did you skate with the NBFSC this past fall/winter session? *

Yes

No (please mail a copy of your proof of Skate Canada Insurance with your payment)

Publicity Waiver

I hereby give the North Bay Figure Skating Club permission to use my name and photograph for publicity purposes such as Newspapers, Radio, Websites, etc. I also recognize the Club has limited to no control should the media take photos for their own use.

Publicity *

Yes

No

TERMS OF MEMBERSHIP:
I do hereby consent and agree that the above mentioned skater may participate in the programs of the North Bay Figure Skating Club. I also agree that the Directors and Coaches of the North Bay Figure Skating Club bear no responsibility for any injury or loss of personal property as a result of such participation and that it is the responsibility of the parent/legal guardian to ensure that the participant is fully covered by medical insurance. I also agree to abide by the rules and regulations as set out by the North Bay Figure Skating Club.

Membership *

Yes

You must submit payment by e-transfer:

You will receive a confirmation order at the email you provided in this application, giving fee details
Pay your fees through your bank by e-mailing the funds to the treasurer (see email below)
The security question should be "Where do I skate?" - indicate northbayfigureskatingclub as your answer and specify your skater's name in the email.
Questions? Contact treasurer@nbfsc.on.ca

Concerns or questions re payment of fees or applying for Kid Sport should be directed to the Registrar@nbfsc.on.ca.