Elite Skate Productions Presents…
The U.S. Seattle Skate Camp
January 2010
Registration
First Name: Last Name:
Address: City: Zip Code:
Phone Number: Email Address:
Birthdate:
Skating Discipline: Division:
Parent Name: Phone Number:
Emergency Contact: Phone Number:
I, , and the Parent/Guardian, if participant is a minor, agree(s) that I/the registrant will abide by the rules of the U.S. Seattle Skate Camp and all affiliated organizations and sponsors. I/the registrant understand(s) failure to abide by the rules and regulations of the U.S. Seattle Skate Camp will result in dismissal from the camp with no refund. I recognize the possibility of physical injury associated with the sport of roller skating and physical training and in consideration for Elite Skate Productions L.L.C. and its roller skating programs and activities; I hereby release, discharge and/or otherwise indemnify Elite Skate Productions L.L.C., it's affiliated organizations and sponsors, their employees and associated personnel, including the owners of the facility utilized for the Program against any claim by or on behalf of myself/the registrant as a result of my/the registrant’s participation in the U.S. Seattle Skate Camp. I will not hold Elite Skate Productions L.L.C. and/or its affiliated organizations responsible for any lost or stolen items.
Registration fee for the U.S. Seattle Skate Camp is ---- and will be paid to
Elite Skate Productions L.L.C. You will be contacted for payment after we receive your registration. Private Lessons will be available for $30.00 an hour individual and $48.00 an hour for teams. This fee will be paid directly to the coaches.
The information contained above and herein is complete and correct, and I/the registrant am/is able to engage in all Program activities.
Signature: Date:
Parent/Guardian Signature: Date:
Please return filled out registration form to: Elite Skate Productions L.L.C.
c/o Joshua Rhoads PO Box 1541, Woodinville, WA 98072 or scan and email to info@eliteskateproductions.com