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Daytime Skating School <br /> 0 0 <br /> a Session <br /> IN� Y <br /> 109419H a+,+:Fi <br /> Department SIATINGOTER <br /> Thursdays, SEPTEMBER 22 - NOVEMBER 17, 2011 <br /> (NO CLASSES ON Oct. 20) <br /> Program # Time Level <br /> 9100.517 l 0:00am-10:30am Preschool 3-4 years old <br /> 9100.518 10:30am-11:00am Adult Skating Lessons & Practice ice* <br /> 9100.519 1 1:00am-1 1:30am 5 years old to early teen <br /> *NEW adult skating lessons are being offered on half the ice while children in the daytime skating school are still <br /> welcome to use the time for practice ice.Adults are highly recommended to wear protective gear including helmets. <br /> There are no provisions for make up classes. <br /> An$8.00 processing charge will be added to all cancellations. <br /> / %�i iii///i/////ic//„%/,,, ✓i iiii <br /> j11(: Ill f ll�y'II f <br /> % <br /> % <br /> n <br /> ii, /li/�iii iiii ✓. <br /> i <br /> 1 <br /> i <br /> Vuuw ii u <br /> i <br /> i <br /> I <br /> II, <br /> I I <br /> �IIII i <br /> 11 <br /> 1� <br /> �I <br /> i <br /> W <br /> Price: Roseville Resident X56, Regular X64 <br /> ____________________________________________________________________________________ <br /> Register Online @ www.cityofroseville.com/skatingcenter <br /> Participants Name: Phone: Parent/Guardian Name: <br /> Home Address: City: State, Zip. <br /> BIRTHDATE: Status: New Student Returning Student Test Passed: <br /> GENDER(circle one): F M PROGRAM#: PROGRAM NAME: �► <br /> M <br /> Does participant have any disability,allergy or special needs of which we should be aware? Explain: <br /> m � <br /> Lo <br /> V o Liability Waiver:I understand that participation in this activity is completely voluntary.I recognize that there are risks in my participation in this activity.I agree to r--r <br /> — cv accept those risks.I also agree,in consideration for my being allowed to participate in this activity,and on behalf of myself,my heir,executors,administrators <br /> IC® v •� r` <br /> o U01 and assigns,to release and discharge the City or Roseville,sponsor(s)of the event or activity,and their officers,employees,agents,successors and/or assigns from CD <br /> O <br /> NWT N <br /> liability for any and all injury,damage or loss that is or may arise from my participation in this activity. <br /> Data Practices Act Notice:Pursuant to the Minnesota Government Data Practices Act,you are being requested to furnish certain information that is classified as <br /> private under the Act.The City collects such information in order to properly process requests to participate in activities.You may refuse to provide such information, <br /> but such a refusal may affect your ability to participate.The information will be maintained by the City Park and Recreation Department,and may be accessible to <br /> anyone in the Department,or in other Departments of the City. <br /> Signature- Date: E-Mail: <br /> Fee Paid Date Paid Check# B <br /> Visa or MasterCard# Exp Date <br /> The Roseville Skating Center reserves the right to cancel or adjust any session due to insufficient enrollment <br />