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Instructions

Please review carefully.

For your convenience, you may print this form to fax or mail.

Please:

  • send all cheques,
    payable to Cindy Bower,
    to:

    NOTE: address change

    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

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    Cindy Bower Power Skating

    Clinic Registration Form

    Your Name
    Must be completed even if same as participant.
    Participant's Name
    Street Address
    City
    Prov/State
    Postal/Zip
    Phone
    Email address
    Birthdate     M     F

     

    Skill Level

         		House League
    Rep. A     AA     AAA
    Team Name

     

    Clinic Selected:







    		March Break 2012 ~ March 12-16

    Private Lessons:   Session 1    Session 2
    Note: To book a private lesson, in addition to completing the registration form, you must contact Peggy to finalize arrangements.
    Group Clinic   
    Parental
    Permission









    		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.
    Yes
    Please note: If participant is of legal age, he/she should complete and sign this form.
    Signature/Name
    Parent/Guardian

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