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r"`� 2012-2013 <br /> �ui�i�h l��l�rr�l��muU���rrrr(rin <br /> mIFR� <br /> AL Parks& <br /> YOUTH BANDY <br /> Rec�eafpn DBpartmeni <br /> Bandy is a fast paced combination of soccer and hockey played on ice without checking. Boys and <br /> girls 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 /> Register by November 11. Late registrations accepted if space is still available. <br /> Call Nancy Nelson @ 651-484-0840 for more information. <br /> � _I✓ f n � ,'�����( (��(¢11 i I�JJ�,,,b;;i ar����!�f i�/ll6 � �p�f� /� <br /> u <br /> �, �. � bY➢�>j W r�°� � �� � was 'S°� <br /> Program# Level Day Time Dates <br /> 9100.581 Beg. Fridays 5:30 - 6:30 pm 11/16/12 - 3/1/2013 <br /> 9100.582 Int. Fridays 6:30 - 7:30 pm 11/16/12 - 3/1/2013 <br /> 9100.583 Adv. Sundays 4:30 - 6:30 pm 11/18/12 - 3/3/2013 <br /> ,No class December 28& 30" <br /> Price: Regular $95, Roseville Resident $85 <br /> Register Online @ www.cityofroseville.com/skatingeenter <br /> Participants Name: Phone: Parent/Guardian Name: <br /> Home Address: City: State: Zip: <br /> BIRTHDATE: Email Address: <br /> O <br /> o GENDER(circle one): F M PROGRAM#: PROGRAM NAME: <br /> Vz Does participant have any disability.allergy or special needs of which we should be aware? Explain: <br /> c <br /> U Sy <br /> v y 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 /> 2 <br /> U > 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 /> y <br /> N N <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 /> liability for any and all injury,damage or loss that is or may arise from my participation in this activity. 0 <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. W <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 />