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<br /> Then speedskating may be the sport for you! Boys and girls ages 4-14 are invited to
<br /> join this introductory program and learn the fundamentals of speedskating in a fun
<br /> environment with experienced speedskating coaches. Participants must be able to
<br /> skate independently. Mandatory orientation meeting at the Roseville Skating Center
<br /> (parents and skaters) Wednesday, November 16 at 6:30pm.
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<br /> OVAL
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<br /> Proszram # Days: Time: Date:
<br /> 9100.512 T, Th 4:30 - 5:20pm Nov 29 - Feb 23* (Limit 45 skaters)
<br /> Open practice ice available to both classes 5:20 - 5:40pm
<br /> 9100.513 T, Th 5:40 - 6:3 0pm Nov 29 - Feb 23* (Limit 45 skaters)
<br /> *No class 12/27, 12/29
<br /> For more information visit: www.rosevillespeedskating.org or www.skatetheOVAL.com
<br /> Price: Roseville Resident $85,, Regular $95
<br /> Register by November 16, 2011. Late registrations accepted, if space available.
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<br /> Register Online @ www.cityofroseville.com/skatingcenter
<br /> Participants Name: Phone: Parent/Guardian Name:
<br /> Home Address: City: State: Zip.
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<br /> BIRTHDATE: Skating Experience(circle one): speedskating hockey skate without assistance
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<br /> GENDER(circle one): F M PROGRAM#: PROGRAM NAME: �A
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<br /> Does participant have any disability,allergy or special needs of which we should be aware? Explain:
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<br /> r' CD
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<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 /> 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
<br /> to O r �►.
<br /> coo 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 N
<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, O
<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:
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<br /> Fee Paid Date Paid Check# B
<br /> Visa or MasterCard# Exp Date
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