Ice-Tech Registration Form for Spring 2012

Please complete all areas of this form, read the Waiver and sign where indicated.
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MAIL TO: Ice-Tech 19 Peachtree Cres. Cambridge, Ontario N1S 4W4 PLEASE NOTE: Please include payment with this form. Cheques only by mail. Cash or cheque only in person No credit cards or debit in person   Skater’s First Name ___________________________ Last Name ____________________________________ Address _____________________________ City _________________________ Postal Code ____________ Birth Date: _______________ Home Phone__________________ Business/Cell Phone __________________ Email: _________________________ Number of Years Skated ____ Parent’s Name ____________________ Medical/Behavioral Notes (if any) _____________________________________________________________ WAIVER: I acknowledge that IceTech Training Centre JPE Inc., and its directors or instructors will not be held responsible or liable for any accident or loss, however caused, and agree to release Ice-Tech from all damages or claims which may arise as a result of such accidents or loss. I hereby give permission to seek out any medical assistance my child (or adult) may require while attending the program.   Date: _______________ Parent/Guardian Signature: _____________________________________________ Payment by CASH or CHEQUE ONLY – no credit cards or debit. All prices include HST. Cheques payable to: IceTech Please “check” a session. All sessions are 50 minutes. Session Day Time Location Session Dates Weeks Total Cost Tots Sunday 9:15-10:05 AM Sportsworld Twin Pads Apr 15-Jun 10 2012 9 $115.00 Tots Sunday 11:40 AM-12:30 PM Cambridge Ice Centre Apr 15-Jun 24 2012 11 $138.00 Tots Sunday 12:40-1:30 PM Cambridge Ice Centre Apr 15-Jun 24 2012 11 $138.00 Tots Saturday 9:40-10:30 AM Cambridge Ice Centre Apr 14-Jun 30 2012 12 $150.00 Tots Saturday 12:15-1:05 PM Sportsworld Twin Pads Apr 14-Jun 9 2012 7 $90.00 Preschool 3 - 5 years Sunday 9:15-10:05 AM Sportsworld Twin Pads Apr 15-Jun 10 2012 9 $135.00 Preschool 3 - 5 years Sunday 11:40 AM-12:30 PM Cambridge Ice Centre Apr 15-Jun 24 2012 11 $165.00 Preschool 3 - 5 years Sunday 12:40-1:30 PM Cambridge Ice Centre Apr 15-Jun 24 2012 11 $165.00 Preschool 3 - 5 years Wednesday 5:10-6:00 PM Cambridge Ice Centre Apr 18-Jun 27 2012 11 $165.00 Preschool 3 - 5 years Wednesday 6:10-7:00 PM Cambridge Ice Centre Apr 18-Jun 27 2012 11 $165.00 Preschool 3 - 5 years Saturday 9:40-10:30 AM Cambridge Ice Centre Apr 14-Jun 30 2012 12 $180.00 Preschool 3 - 5 years Saturday 10:40-11:30 AM Cambridge Ice Centre Apr 14-Jun 30 2012 12 $180.00 Preschool 3 - 5 years Saturday 12:15-1:05 PM Sportsworld Twin Pads Apr 14-Jun 9 2012 7 $105.00 Learn to Skate 6 years - teen Sunday 9:15-10:05 AM Sportsworld Twin Pads Apr 15-Jun 10 2012 9 $140.00 Learn to Skate 6 years - teen Sunday 11:40 AM-12:30 PM Cambridge Ice Centre Apr 15-Jun 24 2012 11 $170.00 Learn to Skate 6 years - teen Sunday 12:40-1:30 PM Cambridge Ice Centre Apr 15-Jun 24 2012 11 $170.00 Learn to Skate 6 years - teen Wednesday 5:10-6:00 PM Cambridge Ice Centre Apr 18-Jun 27 2012 11 $170.00 Learn to Skate 6 years - teen Wednesday 6:10-7:00 PM Cambridge Ice Centre Apr 18-Jun 27 2012 11 $170.00 Learn to Skate 6 years - teen Saturday 9:40-10:30 AM Cambridge Ice Centre Apr 14-Jun 30 2012 12 $185.00 Learn to Skate 6 years - teen Saturday 10:40-11:30 AM Cambridge Ice Centre Apr 14-Jun 30 2012 12 $185.00 Learn to Skate 6 years - teen Saturday 12:15-1:05 PM Sportsworld Twin Pads Apr 14-Jun 9 2012 7 $110.00 Figure Skating 7 yrs - teen Wednesday 6:10-7:00 PM Cambridge Ice Centre Apr 18-Jun 27 2012 11 $178.00 Figure Skating 7 yrs - teen Saturday 10:40-11:30 AM Cambridge Ice Centre Apr 14-Jun 30 2012 12 $192.00 Adults Sunday 9:15-10:05 Am Sportsworld Twin Pads Apr 15-Jun 10 2012 9 $145.00 Adults Saturday 9:40-10:30 AM Cambridge Ice Centre Apr 14-Jun 30 2012 12 $189.00 Adults Saturday 12:15-1:05 PM Sportsworld Twin Pads Apr 14-Jun 9 2012 7 $115.00   Notes:_______________________________________________________________________________________