2012-08-07_PR_Packet - Laserfiche WebLink

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0, 0, L Es �KAT V ki S SC N, 1X_ INf(i FALL 2012 11 WEEK SESSION Tuesdays, Sept. 4 — Nov. 20, 2012 (No classes Oct. 2) PROGRAM# TIME LEVEL JLJ V J 9100.563 5:45 - 6:15pm Tots 3-5 years old(Helmets&Mittens Encouraged)I JLJ CEN JL SLITING TER 9100.564 6:15 - 6:45pm 6-8 years old(*Pre-Alpha-Delta) 9100.565 7:00-7:30pm 6-8 years old(*Pre-Alpha-Beta) 9100.566 7:00-7:30pm Bright Blades 9100.567 7:30- 8:00pm 9-12 years old&teens All Beginners in 6-8 are Pre-Alpha Saturday, Sept. 8 — Nov. 17, 2012 PROGRAM# TIME LEVEL 9100.568 12:00 - 12:30pm Tots 3-5 years old(Helmets&Mittens Encouraged) 9100.569 12:30 - 1:00pm 6-8 years old 9100.570 1:00- 1:30pm 9-12 years old&teens 9100.571 1:45 - 2:15pm Freestyle I &2 pss 9100.572 2:15 - 2:45pm Freestyle 3 Parks&Recreation Department 9100.573 2:45 - 3:15pm Freestyle 4 9100.574 3:30-4:00pm Freestyle 5 9100.575 4:00-4:30pm Freestyle 6-10 REGULAR FEE $110.00 ROSEVILLE RESIDENT FEE $99.00 TO AVOID A $5.00 LATE FEE - REGISTER BEFORE SEPTEMBER 1, 2012. REGiSr .E. . .N. .E..., OP, www froseville.com/skati ter An$8.00 processing charge will be added to all cancellations. Registrations accepted on a first come,first served basis THERE ARE NO PROVISIONS FOR PRACTICE ICE OR MAKE-UP CLASSES Please call 651-792-7007 for additional information. Registrations should be mailed to address on form. KEEP THE TOP OF THIS FORM FOR YOUR INFORMATION .................................................................................................................. ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ Participants Name: Phone: Parent/Guardian Name: Home Address: City: State: Zip: GENDER(circle one): F M BIRTHDATE: STATUS: New Student Returning Student PROGRAM#: PROGRAM NAME: TEST PASSED: Does participant have any disability,allergy or special need of which we should be aware? Explain: LO Lo 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-_ 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 L) ti 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 liability for any and all injury,damage or loss that is or may arise from my participation in this activity. Lo C-4 C.0 Data Practices Act Notice:Pursuant to the Minnesota Government Data Practices Act,you are being requested to furnish certain information that is classified as 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, 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 anyone in the Department,or in other Departments of the City. Signature: Date: E-Mail: Fee Paid Date Paid y Check# B Visa or MasterCard# Exp...Date .......................................................................................................................................................................................................................................................................................................................................................................................... ...................................................................................................................................................................................................... The Roseville Skating Center reserves the right to cancel or adjust any session due to insufficient enrollment.