Syracuse Speed Skating Learn To Skate/Try Speed Skating Registration Form 2022-23

Sponsored by Byrne Dairy
Learn to Skate is held the first Tuesday of every month during our skating session (October through March). Please fill in all three pages and bring the application to US speed skating (page 2) to your first session. We look forward to having you!
Athlete Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Street shoe size *
Skating experience *
In case of emergency please contact: *
Phone Number *

Area Code Phone Number
Relationship *

Please print and fill out the form below and bring it with you to your session. Thank you.

Informed Waiver Consent and Acknowledgement

In consideration of my participation in the Syracuse Speedskating Club, Inc. (SSC) or in any of its activities, I do hereby waive for myself, heirs, executors, administrators and assigns all rights and claims for damage I or we might have against the Club, its officers or members and assigns for any and all injuries and damages suffered by me while participating in, and traveling to, any club activity. This waiver applies equally to and for any minor listed below and/or that I may bring to any activity of the SSC.

I further undertake to skate safely and wear protective equipment at all times as spelled out in the Code of Conduct.

Covid-19 Consent and Waiver:

As a club member, I agree to comply with all club rules, US Speedskating recomendations and any and all facility policies regarding health and covid-19.

I understand that participating in social activities, including speedskating, during this time carries a risk of contracting and/or spreading covid-19. I do hereby waive for myself, heirs, executors, administrators and assigns all rights and claims for damage I or we might have against the Club, its officers or members and assigns for any and all injuries and damages suffered by me stemming from covid-19 while participating in, and traveling to, any club activity. This waiver applies equally to and for any minor listed below and/or that I may bring to any activity of the SSC.

Photography

I hereby grant the Syracuse Speedskating Club permission to use my likeness in photographs and/or video in any and all of its publications, including Web space, and in any and all other media, whether now known or hereafter existing, controlled by SSC, in perpetuity, and for other use by the SSC.
Confirmation

BY AGREEING ABOVE AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT IS EQUIVALENT TO AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
*

I Agree
Parent or guardian if participant is a minor:

First Name Last Name
Contact email:
Learn to Skate for the 2021-2022 Season will be held the first Tuesday of Every month at Sunnycrest Areana 669 Robinson Street, Syracuse, New York from 5:15-6:00. Arrive at 5:15 to be fitted with skates. Wear long sleeves, long pants and gloves, and bring a bicycle helmet.
How did you hear about our Learn To Skate Program? If you were referred by a member please include their name.
Date of Attendance. This should be the first Tuesday of the month unless otherwise confirmed by our coach.
Should be Empty:

Sponsored by Byrne Dairy