Black Panther Figure Skating Club Registration Form
SKATERS INFORMATION
Skater's name
*
Skater's surname
*
Skater's ID Number
*
Skater's DOB
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Race (required by Dept. of Sport for statistical purposes)
*
Please Select
Black
Coloured
White
Indian
Asian
Prefer not to say
Nationality
*
Gender
*
Please Select
Male
Female
Home Address
*
Street Address
Street Address Line 2
City
Province
Postal
PARENT/GUARDIAN/ADULT SKATER INFORMATION
Are you an existing member of Black Panther Figure skating club?
*
Yes
No
If yes, please provide us with your membership number
*
Are you joining as an adult skater?
*
Yes
No
Parent/guardian/adult skater's name
*
Parent/guardian/adult skater's surname
*
Parent/guardian/adult skater's ID Number
*
Parent/guardian/adult skater's cellphone number
*
Format: (000) 000-0000.
Parent/guardian/adult skater's email address
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Relationship to Skater
*
MEDICAL AID INFORMATION
PLEASE COMPLETE ALL THIS INFORMATION
Medical aid name
*
Medical aid number
*
Principle member
*
First Name
Last Name
Family Doctor
Family Doctor contact number
Allergies
*
DISCLAIMERS
Please review the Code of Conduct document here:
Black Panther Figure Skating Club Code of Conduct 2022
I hereby confirm that I have read, understood and will comply with Code of Conduct of Black Panther Figure Skating club at all times. I further acknowledge that I will abide by the rules and regulations of Black Panther Figure Skating Club, The Ice Station and Grand West Casino at all times.I hereby confirm that I understand that information gathered on this form will be used for updating club membership records and consent to this information being shared with Provincial, National and International Figure skating organisations as and when required.Images and videos taken during club times as well as at all local and international figure skating competitions will be used on the social media pages of the club and the respective local and international figure skating organisations and I consent to the use of these images.
*
Skating member acknowledgement
I hereby confirm that I have read, understood and will comply with Code of Conduct of Black Panther Figure Skating club at all times. I further acknowledge that I will abide by the rules and regulations of Black Panther Figure Skating Club, The Ice Station and Grand West Casino at all times.I hereby confirm that I understand that information gathered on this form will be used for updating club membership records and consent to this information being shared with Provincial, National and International Figure skating organisations as and when required.Images and videos taken during club times as well as at all local and international figure skating competitions will be used on the social media pages of the club and the respective local and international figure skating organisations and I consent to the use of these images.
*
Parent/guardian/adult skater acknowledgement
Should membership fees be in arrears for longer the 3 months and no prior arrangements have been made with the club then Black Panther Figure Skating Club reserves the right to cancel all associated memberships and membership numbers without notice or warning
*
Parent/guardian/adult skater acknowledgement
Submit
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