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Please review carefully.

Print this form for fax or post-mail.

  • For your convenience, we can accept payment by email Interac transfer. Please use the pegskate8@cogeco.ca address for this purpose

  • Payment by cheque:
  • Please send all cheques, payable to Cindy Bower, to:

    Cindy Bower Power Skating
    5433 Blue Spruce Ave.
    Burlington, ON
    L7L 7C5

  • Do not send postdated cheques
  • All registrations will be confirmed by email one to two weeks prior to selected clinic.

  • Parental Permission

  • Be aware that both the checkbox and accompanying field, for the parental or guardian signature, are required to be completed

  • If you are printing this form and submitting by regular mail, please sign your name in the space provided

  • For more information, contact Cindy or Peggy

  • Cindy Bower and Peggy Ward

    Power Skating Clinic Registration Form

    Your Name
    Must be completed even if same as participant.
    Participant's Name
    Street Address
    E-mail address
    Birthdate     M     F


    Skill Level House League
    Rep. A     AA     AAA
    Team Name


    Clinic Selected: 2016 March Break

    Private Lessons:
    Session 1     Session 2
    You must contact Peggy to finalize arrangements for a Private Lesson, in addition to completing this registration.

    Group Clinic


    I give my approval to my son/daughter's participation in all activities of the Cindy Bower Power Skating clinics and assume all risks and hazards incidental to such participation, including medical and dental expenses, and do waive, release, absolve and agree to hold harmless the Cindy Bower Power Skating clinic and/or its proprietors and all employees of same.
    Please note: If participant is of legal age, he/she should complete and sign this form.