PPSC 2024/2025 Registration

Skater's Name*

First NameLast Name

Birth Date*

Date

Age*

Gender*

FemaleMaleN/A

Indigenous

Parent Contact Name*

First NameLast Name

Parent Contact Phone*

Parent Contact E-mail*

example@example.com

Secondary Parent Contact E-mail

example@example.com

WhatsApp is our primary method of communication, please list phone number we can use to add to our group. Every Skater must have at least 1 parent or guardian added*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Has your child been previously registered with Skate Canada*

YesNo

Home Club (if other than PPSC)

Coaches Name (if other than PPSC)

Skaters Skate Canada number

WHICH PROGRAM ARE YOU REGISTERING FOR?*

SKATE CANADA MEMBERSHIP FEE (Mandatory Skate Canada insurance fee charged once per skater, per skating year)*

Skate Canada Fee $60

Payment Options (Instalment dates: #1 Date registered, #2 October 1 2024, #3 November 1 2024, #4 December 1 2024)*

Pay Registration in Full4 Monthly instalments Sept-Dec

Applying for KIDSPORT?

Yes

Total requested from KIDSPORT (max $300)

KIDSPORT does not cover the $60 insurance

Total Registration Owing Skate Canada Member fee + Program fee - KIDSPORT FUNDING *

(If KIDSPORT application is denied you will receive a bill from club for remaining registration fee.)

Any Medical Concerns/Allergies/Medications:

Coaching Acknowledgements:*

STAR 1 & up Skaters will be charged monthly coaching fees that are not included in registration fees. These are paid monthly directly to the coaches. (This fee does not apply to PreSTAR or CanSkate)

Check each box to confirm ackowledgment:*

I hereby certify that I am the parent/guardian of the above listed skater and hereby understand and agree to the following as indicatedI Give permission to participate in club activities and agree that I/we will abide by Skate Canada and Peace Passage Club rules and polices. I also agree to pay all monies owing to the club or professionals or lessons or expenses paid by the Club on behalf of the skater.I acknowledge that a portion of the registration fee paid is allocated to Skate Canada and accidental insurance should any occur. I agree to hold harmless and release Peace Passage Skating Club and Skate Canada for all liability for any personal loss, damage or injury of any kind that may be sustained by the skater in any manner while participating in Club activities. I further consent to emergency medical procedures that may be deemed necessary by a licensed medical practitioner as a result of the skaters involvement in Club activities.I agree that Skate Canada and its members, including my local skating club, may photograph, film and/or otherwise reproduce my likeness and/or voice in the course of my enrolment and participation in programs and events conducted or sponsored by Skate Canada or my local skating club (the "reproduction"). I acknowledge that Skate Canada or its designate will own all worldwide right, title and interest in and the reproductions.I hereby irrevocably grant Skate Canada, it licensees and assigns, the right to utilize the reproductions in any and all manner and media, now known or unknown, through the perpetuity. I agree that the reproductions may be edited in the Skate Canada's sole discretions and may be used with or without my name associated with them, I expressly realize Skate Canada, its members, directors, agents, employees, licensees and assigns from and against any and all claims which I have or may have, whether known of unknown for invasion of privacy, misappropriation or personality, defamation or any other cause of action arising out of reproduction.Failure to abide by Club Rules and Regulations may result in revoking of membership by the Club Executive without refund.

A $200 block commitment cheque, post dated for March 13, 2025, per participant, MUST be submitted to the club on or before the first day of skating. This cheque will be DESTROYED upon completion of block commitment or cashed on March 13, 2025 if blocks are not completed.*

I will provide a post dated cheque in the amount of $200I would like to pay my deposit with cash in the amount of $200

Skater Block Commitment*

CanSkate - 1 Gaming, 1 Volunteer, 1 Fundraising (Per Season)PreSTAR/STAR 1 - 1 Fall Gaming, 1 Winter Gaming, 2 Fundraising, 4 VolunteerSTAR 2&up - 1 Fall Gaming, 1 Winter Gaming, 1 Bottle Drive, 4 Fundraising, 5 VolunteerI have more than one skater registered

Signature of Parent or Guardian if under the age of 18*

Date*

Date

FOR OFFICE USE ONLY

	Registration Complete	Skate Canada Complete	Commitment cheque received	Whatsapp
Admin confirms

Waiver:

Fundraising and the Block system