2012-11-01_PR_Packet - Laserfiche WebLink

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�� ro um i I Then speedskating may be the sport for you! Boys and girls ages 4-14 are invited to join this introductory program and learn the fundamentals of speedskating in a fun environment with experienced speedskating coaches. Participants must be able to skate independently. Mandatory orientation meeting at the Roseville Skating Center (parents and skaters) Wednesday, November 14 at 6:30pm. THE � p I JOHN '�(� V�ir OVAL Program# Days: Time: Date: 9100.579 T, Th 4:30 - 5:20pm Nov 27 - Feb 21* (Limit 45 skaters) Open practice ice available to both classes 5:20 - 5:40pm 9100.580 T, Th 5:40 - 6:30pm Nov 27 - Feb 21* (Limit 45 skaters) ,No class Dec.25& Jan. l For more information visit: www.skatetheOVAL.com Price: Roseville Resident $85, Regular $95 Register by November 14, 2012. Late registrations accepted, if space available. -------------------------------------------------------------------------------------------------------------------------- Register Online @ www.cityofroseville.com/skatingeenter Participants Name: Phone: Parent/Guardian Name: Home Address: City: State: Zip: O C BIRTHDATE: Skating Experience(circle one): speedskating hockey skate without assistance C7 CD GENDER(circle one): F M PROGRAM#: PROGRAM NAME: (/1 how Does participant have any disability,allergy or special needs of which we should be aware? Explain: CD U � LO ('D U v � 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 U accept those risks, also agree,in consideration for my being allowed to participate in this activity,and on behalf of myself,my heir,executors,administrators x Zp O 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 CC N liability or an and all injury,damage or loss that is or may arise from m participation in this activity, Y Y 1 Y. 9 Y Y P P Y, 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. 0 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 N anyone in the Department,or in other Departments of the City. I� Signature: Date: E-Mail: W Fee Paid Date Paid Check# B Visa or MasterCard# Exp Date