Certification of Competitor Form

COMPETITOR NAME
FIRST NAME    LAST NAME          

1. The competitor is eligible to enter the events checked. It is agreed that the competitor and family hold the the Ann Arbor Figure Skating Club and BIGGBY Ann Arbor Ice Cube harmless from any and all liability either during practice or the competition, from any and all liability for damages to or loss of property.

2. As a participant, or parent/guardian of a minor participant, in the Bobbie Stoermer Skills & Showcase /Basic Skills Series, I understand that the Bobbie Stoermer Skills & Showcase /Basic Skills Series, or its agents, may take photographs, video and/or film of my, my minor's and/or my family's involvement, participation, viewing or interaction at Bobbie Stoermer Skills & Showcase /Basic Skills Series scheduled ice time, activities, classes or events. I hereby authorize the taking and use of such photographs, video, film or likeness of myself, my minor child (or children), and/or my family in all forms and media and in all manners, including composite or other representations, for any lawful and legitimate Bobbie Stoermer Skills & Showcase/Basic Skills Series purpose, including dissemination and distribution of the same; and further waive any right to approve or object to any finished, modified or derivative product or media.

3. I have read the Concussion Awareness Information located on www.sk8stuff.com and by signing below, I am agreeing to the terms and conditions.

Parent/Guardian
Signature          Date   

Club Officer/Program Director
Signature         Date   

COMPETITOR SIGNATURE
Signature   Date               

Coach    Signature    

Coach Print Name:   Type a label   
      
Registered on U.S. Figure Skating Coaches Registry for the current season?
Yes #   Type a label         

If you are not registered, go to www.usfigureskating.org , click on the Coaches Registration button and follow the instruction for registration.

COACHES WILL BE REQUIRED TO CHECK IN AT REGISTRATION AT EACH EVENT
Phone   Area Code   Phone Number   

E-mail Address:   Email   

CHECKLIST [please be sure the following is included]:

Entry form with U.S. F/S Number    
Club Officer/Program Director Signature re
Check payable to AAFSC    
Events to be entered checked properly     

Michigan Compete USA Series 2 – APPROVAL CODE: 36204