Summit Skating Club Membership Registration Form 2024-25

Club Membership Registration

Summit Skating Club 2024-2025
Skater Name*

First NameLast Name
Skater DOB:*

MonthDayYear
FemaleMale
USFSA#
If you know
YesNo
Parent Name

First NameLast Name
Parent Phone Number
Format: (000) 000-0000.
Parent E-mail (to receive notifications from USFSA and Summit Skating Club)
Skater Phone Number
Format: (000) 000-0000.
Secondary Email or Skater Email (to receive notifications from Summit Skating Club)
Mailing Address:

Street Address / PO Box

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name & Phone Number
Membership Information
Membership Dues for July 2024 through June 2025

First Skater Membership : $90

Subsequent Skater Membership : $55

Introductory Membership* : $60

Collegiate Membership : $115 for 4 years

Associate Membership : $50

Membership includes full US Figure Skating Annual Membership!

* Introductory membership is for a first-time USFSA member or transferring member from Learn to Skate USA and is not renewable.

* Associate membership is for a skater who is a vaild member of another club. USFSA membership is not granted through us.

Checks payable to : Summit Skating Inc

Hand it over to us

Or Send Zelle to :

treasurer@summitskatingclub.org

Or Venmo to :
@Ryoko-Omori

* Summit Skating Club offers scholarships with Summit Foundation Grant to cover the introductory membership. If you are interested in applying, please answer these two addtional questions. SSC will not ask you for any financial information other than proof of participation in one of the three programs below.
Currently receiving Town of Breckenridge Recreational Department ScholarshipCurrently accepted into the Summit School District Free/Discount Lunch ProgramCurrent WIC recipient
2. Please tell us why you want to receive this Scholarship and be part of the Summit Skating Club.
Media Release Parental Consent Form
Please be advised that during events sponsored by Summit Skating Inc., your child may be photographed, video recorded, or interviewed. With your concent, the photograph or video may be reproduced and released for use in media including newspapers, brochures, videos, television, the internet, the club website, social media platforms, posters and displays.
Skater Name*
Yes, my child's photograph or video MAY be reproduced for use in the media.No, my child's photograph or video MAY NOT be reproduced for use in the media.
Parent Signature*

Clear
Date*

MonthDayYear
Date
Participation Agreement and Waiver
I am a parent or legal guardian of the participant listed below. I hereby consent that the participant may participate in activities with Summit Skating Inc, and I hereby execute this agreement and waiver on his/her behalf. I hereby affirmatively state that the said particiapnt is phisically able to participate in said activities. It is understood that activities with Summit Skating Inc involve an element of risk and danger of accidents and knowing those risks, I hereby assume those risks. I hereby agree to indemnify and hold Summit Skating Inc free and harmless from any loss, liability, damage, cost or expense that the particiapnt may incur as a result of the death or any injury or property damage that said participant may sustain while participating in activities with Summit Skating Inc.
Skater Name*
Parent Signature*

Clear
Date*

MonthDayYear
Date
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
Should be Empty:

Club Membership Registration

Membership Information

Media Release Parental Consent Form

Participation Agreement and Waiver