2008-12-02_PR Comm Packet - Laserfiche WebLink

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Youth Bandy Program Bandy is a combination of soccer & hockey played on ice, with no checking. Boys and girls in grades K-12 who can skate are invited to participate. All Bandy players receive a jersey. Equipment required: skates, helmet with face mask, mouth guard, shin pads, elbow pads, bandy stick (purchase through MN Youth Bandy), hats/caps, and ski gloves/mittens. Bandy will be played at the OVAL. Call Nancy Nelson @651-484-0840 for more info. Beginners and Intermediates play on Fridays and advanced players play on Sundays. The program will begin Friday November 14"h, or Sunday November 16th. Register by Nov. tad, late registrations accepted until Nov. 301h. Program# Level Day Time Dates 33 9100.383 Beg. Fridays 5:30 - 6:30 pm 11/14 — 2/27/2009 33 9100.384 Int. Fridays 6:30 - 7:30 pm 11/14 — 2/27/2009 33 9100.385 Adv, Sundays 4:30 - 6:30 pm 11/16 — 3/01/2009 33 9100.386 High school Sundays 4:30 - 6:30 pm 11/16 — 3/01/2009 33 Fee: $85 Regular, $75 Roseville Resident X - PARTICIPANT NAME: PHONE: PARENT/GUARDIAN NAME: ADDRESS: crry: STATE: ZIP: EMAIL ADDRESS: GENDER (circle one): F M BIRTHDATE: PROGRAM #: Does participant have any disabilRy, allergy or special needs? Explain: Liability Waiver: i understand that participation in this activity is compk:,tely votuntary. I reoDgwze that there are risks in my participation in this activity. I agree to Ln accept those risks. I also agree, in consideration for my being allowed to partic[pate in this activity, and on behalf at myself, my heir, executors, administrators CD and assigns, to release and dscharge the Cly or Rosevitle, Sponsor (s) of the event or activity. and their officers, employees, agents, successors and/or assigns from F_ fiabilTty for any and all injury, damage or loss that is or may arise from rry participation in INS acliVtly, 6*Data Practices Act Notice: Pursuant to the Minnesota Government Data Practices A0, you are being requested to furnish certain informationMat is classified as Lf) CQ cc private under the Act, The City collects such infermation in Order to PrOpOdy process TeqUeSI5 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 CAty Park and Recreation Department, and my be accessible to anyone in the Department, or in other Departments of the City, Signature,: , Date: Amount Paid: Cash: Check M Received By: Visa or MasterCard#. Expiration Date: Enroll on-line at www.cityotrosevi Ile. cornJpArks/skatj ngeente , by Mail, or Fax: Roseville Skating Center — 2660 Civic Center Drive — Roseville, MN 55113 Phone 651-792-7007 / Fax 651-792-7120