Clairmont Ag Society

In conjunction with

Sierra Mac Mullin

Present:

Clairmont Skating Club

Recreational Skating Club

Inspiring all students to embrace the joy of skating.

Instructor: Sierra MacMullin

12 years skating experience Jr. Silver Skating Skills

5+ years coaching experience Sr Silver Freeskate

Choreography & Music Partial Gold Dance

NCCP Canskate Trained Gold Interpretive

Former PreNovice Competitor

Please bring registration and payment to the first day of classes.

Session 1: October 15 - November 12

Session 2: November 19 - December 17

Session 3: January 7 - February 4

Session 4: February 11 - March 11

Ages 5-18 9:00am to 9:45pm Saturday & Sunday $300 (5 Week Sessions)

Ages 5-18 4:00pm to 4:45pm Monday & Thursday $300 (5 Week Sessions)

*(You can sign up for all four days or choose from Monday & Thursday classes or Saturday & Sunday classes)*

For more information, contact:

Clairmont Ag Society

780-567-2404

Sierra MacMullin, Coach

587-297-0822

Email:

Please note the following:

  1. All registration forms must be accompanied with full payment
  2. Cash or cheque accepted
  3. Please make all cheques payable to “Clairmont Ag Society”

iv.Refunds issued for medical reasons only and a doctor’s note will be required.

v.Helmets are MANDATORY!

Clairmont Figure Skating Club Registration for Fall/Winter 2016/2017

Skater’s Name:______

Age:______AHC#______

Parent/Guardian Name:______

Home #______Cell #______

Adress:______

City:______Postal Code:______

Email:______

Session:______Paid in Cash:______Cheque#______Total Amount:______

Medical Information

Medical Doctor:______

Emergency Contact:______

Phone Number:______

Allergies or Disabilities:______

Refund Policy: A refund or credit due to program/session time changes & medical reasons will be issued. (physician note may be required)

WAIVER: Applicant hereby waives all claims, rights or causes of action against the Clairmont Skating Club, and Visions Beyond its officers, directors, employees, coaches or members for personal injury or loss of property of any nature, however or wherever sustained.

______Date :______

Signature of skater or of parent/guardian if skater is under 18

I give my permission for the Clairmont Skating Club to use my image (photograph or video) to promote club events and Activities: YES/NO (circle)

I would like to be included in the club email list, to receive periodic information about club events and activities: YES/NO (circle)

2016-2017 Figure Skating Registration FormClairmont Ag. Society