SYR Speed Skating Membership Form 2022 - 2023

Registration and Membership Registration
US SPEEDSKATING MEMBERSHIP

All club skaters, coaches, and board officers must be members of US Speedskating for insurance purposes. Go to US Speedskating and click on Membership Registration to join.

CLUB LOCATION AND SCHEDULE

All practices take place at Sunnycrest Ice Rink, 698 Robinson Street, Syracuse 13206

Practices are Tuesdays and Thursdays 5:15-6:45 pm from November until the end of March

No practice on November 24, December 27, December 29 and March 23.

SKATING AND MEMBERSHIP FEES

Team Membership

$350 for one night per week

$600 for two nights per week

*Must be a member of US Speedskating

Skate Rental

Skate rental is available for $75 per season. Must be paid in full along with a $50 deposit before skating. Deposit will be returned to you at the end of the season upon return of skates in acceptable condition.

Free Try Speedskating

The first Tuesday of every month invite friends to try speedskating for free.

* Must complete US Speedskating 1 day 1 dollar form.

Refund Policy

Skating and skate rental fees are non-refundable

Athlete Information
Athlete's Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Birth Date *

Month Day Year
USS Membership Number *
USS Membership Expiration date *

Month Day Year
_____________________________________________
In case of emergency please contact: *
Phone Number *

Area Code Phone Number
Relationship *
_____________________________________________
I will be renting club skates *

Yes No
_____________________________________________
Add additional athletes in the same family *

Yes No

Additional Athlete Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
USS Membership Number *
USS Membership Expiration date *

Month Day Year
I will be renting club skates *

Yes No
Add additional athletes in the same family *

Yes No

Second Additional Athlete's Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
USS Membership Number *
USS Membership Expiration date *

Month Day Year
I will be renting club skates *

Yes No
Add additional athletes in the same family *

Yes No

Third Additional Athlete's Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
USS Membership Number *
USS Membership Expiration date *

Month Day Year
I will be renting club skates *

Yes No
Add additional athletes in the same family *

Yes No

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.

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 athlete(s) is a minor:

First Name Last Name
Contact email:

Please be sure to select the correct quantity for the number of skaters you are registering.
My Products
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One Night $ 350.00

Quantity

Two Nights $ 600.00

Quantity

Donation $ 10.00
Our club is a 501(c) charity. Financially, our goal is to break even every year. Our expenditures include ice time, equipment purchases and other small expenses. If you wish to make a donation in support, it will be greatly appreciated. Please choose any quantity in $10 increments.

Quantity

Total $ 0.00
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