Saranac Lake Figure Skating Academy
2009 Fall Skating Program
Registration Form
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Skater's Name:___________________________ Skating Level:_____ Age: ___
Parent's Name(s)__________________________________________________
Address: __________________________City:__________________Zip:______
Phone: _____________________ E-mail: ______________________________
Remember to print & fill out USFSA form for your skater - link on registration page
PARENTAL CONSENT AND INDEMNIFICATION AGREEMENT
I, the minor’s parent and/or legal guardian, understand the nature of the above referenced activities and the
minor’s experience and capabilities and believe the minor to be qualified to participate in such “activity”. I
hereby release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD
HARMLESS each of the Releasees from all liability, claims, demands, losses, or damages on the minor’s
account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or
otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or
anyone on the minor’s behalf makes a claims against any of the above Releasees, I WILL INDEMNIFY, SAVE
AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability,
damage, or cost any Releasees may incur as the result of any such claim.
Skater's Name:________________________________________ Date: _______________
Printed Name of Parent/Guardian: ______________________________
Signature of Parent/Guardian: _________________________________
Official Use Only: Date: ____________
Total paid: $_________ balance: $______ check #: ___________ cash: ______
Basic Skills 6 through Super Skaters Only!
Basic Skills: $195.00
+ $10 USFS
Super Skaters: $195.00
+ USFS Registration: $40.00
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