Clone of Skater Registration Form

General Information:

Basic Skills Learn to Skate Program-

SUNY Geneseo's Ira S. Wilson Ice Arena

Winter Session- January 10th - February 28th

8 Weeks total.

Class Time- 10:00 to 11:20 AM

Suggest arriving at 9:45 AM on normal class days and 9:30 AM on Registration Day

Payment Methods- Cash (Exact Change) or Check or Credit Accepted on Registration Day. Please consider cash or check to help the club avoid paying credit card fees.

Cost- $165 per 8 week session plus a non-refundable insurance fee of $18.50 for at least one 8 week session.

General Information - Each skater must provide their own skates. The club does not provide ice skates. Lessons are 20 minutes long with the remainder of the time being free skate time. Parents are welcome to join their child on the ice. You will need to register yourself as well and pay the $18.50 insurance fee.

One Registration form per Skater must be completed.

Registration Session- *

Winter; January 10th-February 28th

Skater Name*

First NameLast Name

Birth Date*

MonthDayYear

Age*

US Citizen?*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent or Guardian Name*

First NameLast Name

Parent E-mail*

example@example.com

Parent Phone Number*

Parent Mobile Number

Emergency Contact*

First NameLast Name

Emergency Contact Relationship

Emergency Contact Phone Number*

Please enter a valid phone number.

Have you ever been a Basic Skills Skater previously?

If yes, answer next question.

Last Skill Level Passed?

By checking the box below, I do hereby authorize a representative from the Skating Club of the Finger Lakes to obtain whatever necessary medical treatment may be deemed necessary for my minor child while participating with the Skating Club of the Finger Lakes Basic Skills Learn to Skate Program*

Agree to medical treatment, if necessary.

By checking the box below, I do hereby authorize the Skating Club of the Finger Lakes to use photographs of my minor child in periodic newsletters and/or, the clubs website. I further understand and agree that my child's first and last name will accompany picture in any monthly publications, and that my child's first name only will be published on the website. I further understand and agree that the pictures will only be used to encourage amateur athletes and to promote the sport of figure skating.*

YesNo

By checking the box below, I agree to adhere to the policies of the Skating Club of the Finger Lakes Basic Skills Learn to Skate Program.*

Agree to adhere to policies of the Skating Club of the Finger Lakes Basic Skills Learn to Skate Program.

ASSUMPTION OF RISK, WAIVER AND RELEASE, AND INDEMNIFICATION AGREEMENT In consideration of the opportunity to participate in Learn to Skate USA sanctioned events and activities during the 2025-2026 season (“Events and Activities”), the undersigned, individually, and on behalf of his/her heirs, personal representatives, administrators, agents, successors and assigns (collectively referred to herein as "Participant"), AGREES TO ASSUME THE RISK AND RESPONSIBILITY, TO RELEASE AND TO INDEMNIFY Learn to SUSA and U.S. Figure Skating, their directors, officers, members, employees, officials, committees, volunteers, clubs, affiliates, sponsors, representatives, agents, successors and assigns, including the host club, local organizing committee and any other entity responsible for the hosting, sponsoring, sanctioning and/or conduct of the Events and Activities (collectively referred to herein as "Learn to Skate USA"), as follows: 1. Assumption of Risk and Responsibility. Participant fully understands and appreciates the risks of injury that may occur in ice skating or in the course of preparing for, participating in and traveling to or from the Events and Activities. The risks of injury that may occur include, but are not limited to, the risk of, serious bodily injury, viral infections, bacterial infections and risk of other communicable diseases and illness, permanent disability, paralysis and death (collectively referred to herein as “Risks”). Participant acknowledges that Participant voluntarily engages in such Events and Activities with adequate knowledge of such Risks; and agrees that Participant fully assumes all such Risks and all legal and financial responsibility for (a) any and all injuries or damages, whether to person or property, that Participant may in any manner sustain in connection therewith or in the conduct and management of the Events and Activities, including such injury or damage that may result from the negligence of Learn to Skate USA or from some other cause and (b) all treatment, hospitalization and other care rendered to Participant in the event of Participant’s illness, injury or other emergency circumstance in connection with participation in the Events and Activities, subject to any applicable insurance coverage. 2. Release and Indemnification. Participant hereby fully and forever releases, discharges, holds harmless, and agrees to indemnify Learn to Skate USA from and against any and all liabilities, claims, demands, lawsuits, damages, and judgments, present or future, known or unknown, valid or invalid, direct or consequential, together with reasonable costs and attorneys’ fees, which result directly or indirectly from damages, losses, injuries or death to Participant, Participant’s property, other persons or property incurred during or in connection with any activities associated with or being a part of the Events and Activities and the conduct and management thereof, including any participation, travel or medical treatment, hospitalization or other care rendered in connection with the Events and Activities, whether such loss, damage, injury or death results from the negligence of Learn to Skate USA or from some other cause. I HAVE READ THIS ASSUMPTION OF RISK, WAIVER AND RELEASE, AND INDEMNIFICATION AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I AND THE MINOR HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE. I INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THAT THE REMAINING PROVISIONS SHALL CONTINUE IN FULL FORCE AND EFFECT.*

Date*

Date

My Products*

Winter Registration Fee- 1st Family MemberRegistration Fee of $155 for each 2nd and subsequent skater under one household. Enter Coupon Code "FAMILY" to receive discount.

$165.00

Learn to Skate Fee Insurance Fee- Required for ALL Levels and All Members.NOTE- This fee only needs to be paid ONCE annually. It will NOT need to be paid in the Winter Session if you skate in the Fall Session.

$18.50

Fall Registration Fee - Additional Family MemberRegistration Fee of $155 for the second and subsequent skaters in the same household.

$155.00 Quantity

Enter coupon

Total

$0.00