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 _______
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:
|
|
|
|