Wilmington FSC Learn to Skate Program 2010-2011:  File Copy – Please print clearly          

Skaters name: ________________________________________DOB: _________________M _____F______
Parents Name:  ____________________________________________________Tele # __________________
Address: ___________________________________________Town: _______________Zip ______________

**PLEASE ENTER AN EMAIL ADDRESS, We will send updates and information throughout the year!
(We will not sell or distribute your address to anyone.)

**E-mail address ____________________________________________________________________________

Highest level of skating achieved (please circle the badge level your child is
IN)

My child has never skated in a skating program______________  child’s age_______________    

Snowplow Sam/Tots:  1, 2, 3 (Ages
4+)            Where Skated _________________                          
Badge: 1  2  3  4  5  6  7   8                                Where Skated _________________                    
Freestyle: 1  2  3  4  5  6                                     Where Skated _________________

Please send the completed form to: Wilmington Figure Skating Club, PO Box 219, Wilmington MA. 01887.
Attention Badge Coordinator.  Deposit fee of $25.00 due with registration form.  Balance due by the first night.


It is the policy of the WFSC not to refund any monies except in those cases where serious injury and/or illness
render that skater unable to participate for an extended period of time.  These conditions should be brought to the
attention of the Board of Directors as soon as possible and be supported by a medical note/evaluation.  
Injuries/illnesses, which result in a limited absence, will not be considered.  One makeup class is allowed per session
and must be used during the session in which it was missed.  Single blade skates are required.  Helmets are
required for all skaters ages 4-6 and for anyone who has never skated.

                                           
Parent/Guardian (please sign)________________________________________________________________

                                                         
Class Schedule Below














All classes are held at the Ristuccia Memorial Arena, 190 Main Street, Wilmington
For further information, please call 978-694-9650
or e-mail WFSC4KIDS@Verizon.net.

Please Make Check payable to WFSC
.  A fee of $25 will be charged for any returned check.

Session 1     Deposit/date ________Check # ________Balance ________Check # ________ PIF _______
Session 2     Deposit/date ________Check # ________Balance ________Check # ________ PIF _______
Session 3     Deposit/date ________Check # ________Balance ________Check # ________ PIF _______
Session 4     Deposit/date ________Check # ________Balance ________Check # ________ PIF _______
Session 5     Deposit/date ________Check # ________Balance ________Check # ________ PIF _______
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USFS #____________________
Class
  X
Fridays  4:00-4:50
X
Fridays 5:20-6:10
   
Session 1
9/10-10/29/10
        $104
 
Session 2
11/5-12/17/10
        $  91
 
Session 3
1/7-2/18/2011
  No Classes 2/25
  No Classes 2/25
$  91
 
Session 4
3/4-4/29/2011
  No Classes 4/22
  No Classes 4/22
$104
 
Session 5
5/6-6/24/2011
        $104
 
A $12.00 Registration Fee is due at initial signup only.  Valid from 7/1/10 - 6/30/11
  $12
                                                                                                    TOTAL: