Summer Canskate/Superskate 2005 - Application
| Skater's Name ______________________________________ |
| Birth Date ________________________________________ |
| Address __________________________________________ |
| _________________________________________________ |
| Postal Code _______________________________________ |
| Medical No. _______________________________________ |
| Skate Canada No. __________________________________ |
| Parent's Name _____________________________________ |
| Phone No. _______________________________________ |
| PLEASE BOOK: |
| Canskate ______________ Superskate _________________ |
| Two Weeks, Starting |
| July 18th _________________ AND/OR August 2nd ______________ |
| In consideration of my acceptance to the Winnipeg Summer Skating School "Summer Canskate/Superskate Program", I agree to hold and save harmless the Dakota Community Centre Inc., it's employees, and the Winnipeg Summer Skating School's coaches, employees, and directors jointly and severely from any claim for injuries sustained while on the Dakota Community Centre Inc. property or premises, or for loss of, or damage to personal property. |
| Parent's Signature ____________________________________ |
| Date_________________________________________ |
| Cheque made payable to: Winnipeg Summer
Skating School. Mail to: W.S.S.S., #1506-55 Nassau St., Winnipeg, MB, R3L 2G8 |