Wheeling Skate Club, Inc20L9-2020 Reg istration Information

REGISTRATION AND VOLUNTEER FORM

Skater's/Member Name

Skater's/Member Add ress

DOB Age-

** Registration fee includes membership to Learn To Skate unless already a member elsewhere xx

PLEASE SELECT ONE OF THE FOLLOWING MEMBERSHIP TYPES: (one form per person)(See types of membership for an explanation of each category)

Snowplow Sam $135 per sessionFull Skating Member

Friday, Only FigureSunday Only FigureHockeySpeed SkateAdult MemberAssociate Tier OneAssociate Tier Two 9185Alumni Member $85

PARENT/GUARDIAN CONTACT INFORMATION (reguired for a skater's/members under 18 yrs of age)Parent/Guardian Name and Address

(If different from above)

Cell Phone (required) ( Home Phone (

E-mail Address (required)

*xfn case of cancellation, Please refer to REMIND or visit FaceBook @ Wheeling Skate Club

VOLUNTEER INFORMATIONI would be willing to help with activities for the club: YES or NO (Circle one)How would you like to help the club:

$410

$20s$20s$20s$20s$85 per session

$24A

) )

Make Check Pavable to: Wheeling Skate Club

Mail registration aaoerc and fees to:Wheelins Skate Club f, .,@s*rynse, 3o\r uJncc\t!\ . Nv cEte oate, wf zeo:a-ti:i - - o

For office use only: Total fccs due Chcck number Cash

Paidin Full AMOUNT Paid in FULL DATECC

Revision 8/22/2019

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Skater's Name

Wheeling Skate ClubMedical Release Form

Birth Date:

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Parent/Guardian Name: Home Phone:

Cell Phone:Address:

City: State: Zip Code:

Note: It is required that all skaters in SNOWPLOW SAM as well as LTS I & is strongly recommendedfor LTS 2,wear a HELMET while on the ice. It is also required that a parent or guardian of a skater 10years or younger be present AT ALL TIMES when he/shc is at the rink for activities and lcssonsorganized by the Wheeling Skate Club.

CONSENT FOR MEDICAL ATTENTION OR TREATMENTI certify that l, the member, or l, the parenuguardian of said participant, give my consent to the Wheeling Skate Club and the facility the

activities are taking place in and their staff and to members of the Wheeling Skate Club, their Board of Directors and volunteers to obtain

medical care from any licensed physician, hospital, clinic, including transportation and emergency medical services, for myself/ourselves

and/or said participant for any injury that could arise from participation in these activities.

PURPOSE OF THIS FORM:

Authorization for emergency treatment of a skater when a parent or guardian cannot be reached:

I hereby authorize first aid and/or emergency trcatmcnt to be provided as nccdcd:

Signed (in ink) Date:

Medical Infonnation:

Physician:

Hospital

Dentist:

Phone:

Phone:

Phone:

Alternative Numbers to Call:

Name:

Relation:

Phone:

Cell:

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Allergies:

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Waiver and Release of Liability, Assumption of Risk and lndemnltyAgreement

Wheeling Skate Club

ln consideration of participating in Wheeling Skate Club activities, I represent that I understand the nature of figure skating activities(activity) and that I am qualifled, in good health and in proper physical condition to participate in such "activity". I acknowledge that ifI believe event conditions are unsafe, I will immediately discontinue participation in the "activity".

I fully understand that this "activity" involves risks of serious bodily in.iury, including permanent disability, paralysis and death, whichmay be caused by my own actions, or inactions, those of others participating in the "activity", the conditions in which the "activity"takes place, or the negligence of the "releasees" named below, and that there may be other risks either not known to me or notreadily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I

incur as a result of my participation in the "activity".

I hereby release, discharge, and covenant not to sue the Wheeling Skate Club. , United States Figure Skating, its directors,officers, administrators, sponsors, volunteers, agents, employees, staff, instructors, trainers, other participants and if applicable,owner and lessors of premises on which the "activity" takes place (each considered one of the "Releasees" herein) from all liability,claims, demands, losses, or damages on my account caused or alleged 1o be caused in whole or tnpart by the negligence of the"releasees" or otherwise, including negligent rescue operations; and I further agree that if, despite this release, waiver of liability, andassumption of risk, I , or anyone on my behalf, makes a claim against any of the "Releasees" , lwill indemnify, save, and holdharmless each of the releasees from any loss, liability, damage, or cost which any may incur as the result of such claim.

The Wheeling Skate Club. has the right, but not the obligation, to provide rules, regulations and/or ice monitors for Club lce. Wehereby acknowledge that the Wheeling Skate Club shall not be responsible for the supervision of the members at Club lce.

l, the minor's parent and or legal guardian, understand the nature ofthe above referenced activities and the minor's experience and

capai-riiities and believe the minorto be qualified to participate in such "activity". I hereby release, discharge, covenant not to sure

anC AGRSE TO INDEIVNIFY AND SAVE AND HOLD HARI/4LESS each of the Releasees from all liability, claims, demands, losses,

or damilges on the minor's account caused or alleged to have been caused in whole or in part by the negilgence of lhe Releasees

or otherwise, including negligent rescue operations, and further agree that if, despite this release, l, the minor, or anyone on the

rninof s behaif makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARI\iILESS each of the

Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost and Releasees may incur as the result of any

such claim.

I have read the WAIVER AND RELEASE OF LIABILITY, ASSUIVPTION OF RISK AND INDEIVNITY AGREEIVENT, understand thatI have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature andintend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portionof this agreement is held to be invalid, the balance, notwithstanding, shall continue in full {orce and effect.

Name of participant/skater Date

Signature of ParticipanUParent/Guardian

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Revised 8124117

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Wheeling Skate CIub

Media Release Form

NAME AND LIKENESS RELEASE AND CONSENT AGREEMENT By registering as a member of theWheeling Skate Club, and the United States Figure Skating Association ("USFSA"), and for good and

valuable consideration, I release and grant to the Wheeling Skate Club and USFSA, including itssubsidiary and affiliated entities, and USFS authorized local organizing committees, clubs, andinterclub associations, the right to use my name, likeness, image, photograph, voice, video, athleticperformance, biographical information and any other indicia of identity, in any format whatsoever,from any Wheeling Skate Club or USFS event or activity in which I participate during the currentseason (collectively, my "ldentifications"), and to distribute, broadcast and exhibit my ldentifications,without charge, restriction or liability, in any media now known or hereafter devised (including, butnot limited to, television, internet, club website, webcasting, and video streaming) or in variouspublications (including, but not limited to, club website, news articles, directory or media guide andmarketing materials) into perpetuity, unless otherwise specified and agreed upon.

I understand that I will not receive any compensation for any such use of my ldentifications. lt is also

agreed that at no time can Wheeling Skate Club or USFS release or authorize the use of myldentifications to an unrelated third party for the purpose of my endorsement of any commercialproperty, product or service, without my written permission.

CHECK ONLY ONE.

I HAVE READ THIS RELEASE AND DO CONSENT AGREEMENT, FULLY

UNDERSTAND ITS TERMS, AND HAVE SIGNED IT FREELY AND WITHOUT ANY

INDUCEMENT OR ASSURANCE OF ANY NATURE.

I HAVE READ THIS RELEASE AND DO NOT CONSENT, YET FULLY

UNDERSTAND ITS TERMS, AND HAVE SIGNED IT FREELY AND WITHOUT ANY

INDUCEMENT OR ASSURANCE OF ANY NATURE. I UNDERSTAND THE SKATER'S NAME

WILL NOT APPEAR IN ANY PUBLICATION NOR WILL ANY PHOTO BE USED.-

Signature of Skater/Member Signature of Parent/Guardian {if under 18 years of age)

Date

Revision OBIT/2AU

Printed Name of Skater/Member

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U.S. Figure Skating Skater and Parents/GuardianCode of Conduct

Codes ofCondtrct git,e eventone a guide lo what i.s erpected ofus iJ u,e are port of'ot1 ot'ganizatiotl, participoting in o sport or as spectators ol olttchild's evcnt.

Preamble: The essential elements ofcharacter-building and cthics in sports are ernbodied in thc concept ofsportsmanship and sir core principles: respect,

charuclcr" (Arizona Spons Sumrit Accord)

By signing below I hereby agree that:

l. I wili ctlcourage good spottsmanship by dernonstrating positive support for all skaters. coaches, and offlcials at every praetice session,rornpctition- and lest session.

1. I u,iii place the emotional and physrcal weil being of my child ahead of my personal desire to win-

3. I rvill cncouragc my child to skatc in a salt and hcalthy cnlironment.

4. I will infonn my child's coach of any physical disability or ailmcnt that may aff'ect the safery of nry child or the sattry olothers.

5. I rvill teach my child that doing one's best is more important than winning; so that, my child wiil nel'er t-eel del'eated by the results o1'acornpetitive event.

6. I will never ridiculc or yell at my child or other participanrs lor makin_[ a r.nistakc or blame my child's teammates tbr placement in acornpetition.

I will do nry bcst to make skating lun and will remembcr that nry child participates in sports lbr his/her ou,n en1oyment and satisfaction -not mine.

8. I will ask nry child to treat other skaters, coaches. lans. and officials with respeci, regardless of race, creed, color sexual tx'ientation orability.

9. I rvill applaud a good ellbrt in both victory and deleat ernphasizing the positive accomplishments and leaming fronr t.he nristakes.

10. I will teach my child to resolve conflicts without resorting to hosti lity or violence .

1 1. I will be a positive model fbr nr1, child and other skaters.

12. Iwilldenratrdaligureskatingenvironntentformychildthatisfl'eeofdrugoralcoholabuseandagrcethatlwillnotuseorprovidetoathird party any drug prescribed by applicable f'ederal, state and municipal [aw.

13. I will not assist or condone any r:ompeting athlete's usc ola drug banned by the International Olympic Committee, Intemational SkatingUnion, United States Olynrpic Comtnittee, ol U.S. Figure Skating, or, in case of athlete. to use such dmgs or refuse to submit to properlvconduct drug tests administeled by one of these olganizatit-rns.

14. Irvill notprovidealcohol to.orcondonetheuseotalcohol hyrninors.abusealcohol inthepresenceofathleternerrbers,oratU.S.Figure skating activities or. in the case ofathletes. consullle alcoholic bcverages while a minor.

15. Iwillcncoura-qemychild'scoachtoconlinuetheireducationandtrainingthroughpro-cramsoifercdbyU.S.Fi_rureSkatin_q,thcProt'essional Skatcrs Association and other accrcdited organizations.

I6. Iwillrcspcctmychild'scoachandreliainfrorncoachingmychildorotherskatersduringcompelitionsandpracticesbecauscitrnayconflict with the coach's plan or strategies.

17. Iwill respectthedecisionsofofficialsandtheirauthodtydru'ingcompetitionsandtestsessionsandteachmychildtodolikewise.

18. I will show appreciation ancl recognizc the importance ofvolunteers and club officials.

19. IwillsrudytherulesoftheU.S.FigureSkatingandteachrnychildaccordinglysothatwehavcanunderstandingandappreciationofthemles of competition and membership.

20. Iwillsupponallthcopponentsinmychild'sconrpetitionandrespecttlrerightsofall skaterstopanicipare-

S i gnature of Skatcr,Mcn.rber:

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Signature of Parent/Guardian:

Date'

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