First Push Skate Coaching Program

The United Skates First Push Skateboarding Group Classes will be held on Sundays, 11am outside Kallang Stadium Skatepark.

Please register your interest and information below. You may register as many skaters as you wish along with their any health or medical backgrounds we should be aware of.

Please note that there is a minimum enrollment of 6 students before classes can commence. We will inform you as soon as minimum enrollment is reached.

United Skates First Push 滑板团体课程将于周日上午 11 点在加冷体育场滑板场外举行。

请在下面注册您的兴趣和信息。您可以注册任意数量的滑板运动员，并告知我们应该了解他们的健康或医疗背景。

请注意，课程开始前至少需要 6 名学生报名。一旦达到最低报名人数，我们将立即通知您。

Skater's Information

1. Skater's Name

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemaleRather Not Say

2. Skater's Name

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemaleRather Not Say

3. Skater's Name

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemaleRather Not Say

4. Skater's Name

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemaleRather Not Say

5. Skater's Name

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemaleRather Not Say

Parent/Guardian Information

Name

First NameLast Name

Home Number

Mobile Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Does the Skater have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the Skater prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by United Skates Pte Ltd during the selected camp. In exchange for the acceptance of said child’s candidacy by United Skates Pte Ltd, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless United Skates and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against United Skates Pte Ltd including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including skateboarding. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to United Skates Pte Ltd and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Signature