|
04 14 14
<br /> ro*"" 2 O ."AINAI Mm 2 0 .412
<br /> DII11����a»ai���l6�>Ia
<br /> TIHE
<br /> G.,,J I D/I.1 T 10 1 f l 1,1FZ, r I'.
<br /> OVAIII
<br /> V�« Perks&Recreation C3eparPrmeen5
<br /> Bandy is a fast paced combination of soccer and hockey played on ice without checking. Boys and girls
<br /> in grades K-12 who can skate are invited to participate.
<br /> Equipment required: skates, helmet with face mask, mouth guard, shin pads, elbow pads, bandy stick
<br /> (purchase through MN Youth Bandy). All Bandy players receive a jersey.
<br /> Call Nancy Nelson @ 651-484-0840 for information. Register by November 11.
<br /> Late registrations accepted if space is still available.
<br /> ../;: i l';oaf/WI 1,,,� ,N..,
<br /> er�ay
<br /> ................................
<br /> n
<br /> I;r
<br /> I
<br /> s, ..a� ;.`..'.q. �•^-w �. Jy .._t,.._:.x -w"zi
<br /> JP
<br /> ,
<br /> m
<br /> r
<br /> I I
<br /> .,.....-,.., _. .,:�.,.,-...._,....:: ,._t„« :.w�.:�_.w_.,. :._.�..- '•_ � u� ra 1 11
<br /> I
<br /> h
<br /> r
<br /> .. 4 ,....,�.,_ ..,. ......:..�. ,��...-e”„�.. ..:: 1,4 i Il 4✓,,, or,�r N ,�r,�. i�Y�" /����1 ��j,�/�".m��
<br /> n
<br /> ;.,n AIR'
<br /> � ^.r; ;;::� �G•..T :'' '.• ¢�/�ark; t�w.� rti„
<br /> p°
<br /> ,
<br /> kr
<br /> ..v Ih
<br /> ��
<br /> �dw
<br /> e '
<br /> .,.• N r r1� � r "t s s w nz
<br /> .a
<br /> Program# Level Day Time Dates
<br /> 9100.514 Beg. Fridays 5:30 - 6:30 pm 11/18/11 - 3/2/2012
<br /> 9100.515 Int. Fridays 6:30 - 7:30 pm 11/18/11 - 3/2/2012
<br /> 9100.516 Adv. Sundays 4:30 - 6:30 pm 11/20/11 - 3/4/2012
<br /> *No class December 23, 25 or 30 and January 1*
<br /> Price: Roseville Resident X85, Regular X95
<br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
<br /> Register Online @ www.cityofroseville.com/skatingcenter
<br /> Participants Name: Phone: Parent/Guardian Name:
<br /> Home Address: City: State: Zip.
<br /> BIRTHDATE: Email Address:
<br /> O
<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 /> U)
<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
<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 /> CCU •> a�
<br /> ( 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 N
<br /> NO O
<br /> W to 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 /> N
<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 />
|