2009-06-09_PR Comm Packet - Laserfiche WebLink

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SUMMER 2009 / 8 WEEK SESSION Wednesdays, June 17 - August 12, 2008 PROGRAM # TIME LEVEL 9100.402 12:00 - 12:30pm Tots 3-5 years old 9100.403 12:30 - 1:00pm 6-8 years old 1:00 - 1:20pm Practice ice (Tots through 9-12 years & teens) 9100.404 1:20 - 1:50pm 6-8 years old 9100.405 1:20 - 1:50pm Bright Blades 9100.406 2:00 - 2:30pm 9-12 years old & teens 9100.407 2:30 - 3:00pm Freestyle 2&3 9100.408 3:00 - 3:30pm Freestyle 1 9100.409 3:45 - 4:15pm Freestyle 4&5 9100.410 4:15 - 4:45pm Freestyle 6-10 ROSEVILLE RESIDENT FEE $68.00 NON-RESIDENT FEE $76.00 TO AVOID A $5.00 LATE FEE - REGISTRATIONS ARE DUE BEFORE JUNE 10, 2009. REGISTER ONLINE @ www.cityofroseville.com/skatingcenter An $8.00 processing charge will be added to all cancellations . Registration is 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: 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 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 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 liability for any and all injury, damage or loss that is or may arise from my participation in this activity. 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 Check # By Visa or MasterCard# Exp Date The Roseville Skating Center reserves the right to cancel or adjust any session due to insufficient enrollment.