Panthers Snowflake Classic 2015 Panthers takes great pleasure in inviting you to the 9th SNOWFLAKE CLASSIC INVITATIONAL DATE: Friday, January 23rd, 2015 Saturday, January 24th, 2015 Sunday, January 25th, 2015 LOCATION: Panthers Gymnastics Club 1016 Marion Street, Winnipeg, MB, R2J 0K8 CLUB MANAGER/ HEAD COACH Robert Persechino MEET DIRECTOR: HEAD COACH Hélène Desmarais CATEGORIES & FEES: Regional Stream Provincial and National Stream Tumbling, Trampoline and Double Mini (204) 898-9056 [email protected] (204) 232-4244 [email protected] $55 $80 $80 for all events or $65.00 for 1 or 2 events AWARDS & EQUIPMENT: As per the technical regulations. PAYMENT: Make one club cheque payable to: Panthers Gymnastics Club ENTRY DEADLINE: Must be received by November 30th, 2014 CHANGES: $5.00 for each change to your original registration. You must use the form included in this document and e-mail it to the meet director. LATE ENTRY: $20.00 late fee per gymnast will be requested after November 30th. No Registration accepted after December 15th. REFUND: Only Medical Refund requests will be accepted until December 15th and will be provided after receiving the Refund Request Form (last page) signed and accompanied by a Doctor’s Medical Report for each athlete. A $30.00 administration fee will be retained on each refund. No Refunds after December 15th. Schedule will be sent and posted by December 15th, on our website at: www.panthersgymnastics.ca Panthers Snowflake Classic 2015 Athlete’s Waiver In consideration of your acceptance of my participation, I, intending to be legally bound, do hereby, for myself, my heirs, executors, and administrators, waive and release and forever discharge any and all rights and claims for losses, damages and /or injuries which I may or may hereafter accrue to me against the Manitoba Gymnastics Association and the Panthers Gymnastics Club, or their respective officers, staff, agents, representative and / or assigns for any and all losses, damages and injuries which may be sustained and suffered by me in connection with my association with or entry in the Snowflake Classic 2015, any activities associated with, or which may arise out of my traveling to , participating in and returning from, said event. ________________________________________ Participant’s Name (please print clearly) ________________________________________ Participant’s Signature (only if over 18) ____________________ Date ________________________________________ Parent /Guardian Name (please print clearly) ________________________________________ Parent /Guardian Signature (only if Participant is under 18) ____________________ Date Privacy Act Request As per the Privacy Act, consent is required to publish your daughter’s name and results in the media. Please complete this form if you give permission to have your daughter’s name, club and results posted on: The Panthers and MGA website And/or published in the newspaper And/or reported on TV and/or Radio This form must be signed by a parent/guardian if competitor is under 18 years of age. NAME: ___________________________________________ I give consent to use my daughter’s name, club and results achieved at: Snowflake Classic 2015 January 23-25, 2015 Panthers Gymnastics Club, 1016 Marion Street, Winnipeg To be included in media releases provided to all media as well as to be used on the Panthers and MGA website. Signature ____________________________ Date: __________________________ Panthers Snowflake Classic 2015 ENTRY FORM Regional Stream CLUB __________________________ CONTACT PERSON _____________________ COACHES: Name of Coach GCG # Coach will be on the floor with: (Please write the Category/Level) PHONE_________________ E-MAIL ______________________________________TOTAL FEES_________ *Please make a Club cheque payable to Panthers Gymnastics Club *Please list your gymnasts in order of Level and Age Category. Regional: $55.00/ Gymnast Name Birth date MM/DD/YY GCG # Level Age group Fee Panthers Snowflake Classic 2015 ENTRY FORM Provincial Stream CLUB __________________________ CONTACT PERSON _____________________ COACHES: Name of Coach GCG # Coach will be on the floor with: (Please write the Category/Level) PHONE_________________ E-MAIL ______________________________________TOTAL FEES_________ *Please make a Club cheque payable to Panthers Gymnastics Club *Please make sure to list your gymnasts in order of Level and Age Category. Thank you! Provincial: $80.00/ Gymnast Name Birth date MM/DD/YY GCG # Level Age group Fee Panthers Snowflake Classic 2015 ENTRY FORM National Stream CLUB __________________________ CONTACT PERSON _____________________ COACHES: Name of Coach GCG # Coach will be on the floor with: (Please write the Category/Level) PHONE_________________ E-MAIL ______________________________________TOTAL FEES_________ *Please make a Club cheque payable to Panthers Gymnastics Club Please make sure to list your gymnasts in order of Level and Age Category. Thank you! National: $80.00/ Gymnast* Name Birth date MM/DD/YY GCG # Level Age group Fee Panthers Snowflake Classic 2015 ENTRY FORM T&T CLUB __________________________ CONTACT PERSON _____________________ COACHES: Name of Coach GCG # PHONE_________________ E-MAIL ______________________________________TOTAL FEES_________ *Please make a Club cheque payable to Panthers Gymnastics Club Please write clearly the appropriate level of your athlete for each events participating in. T&T: $80.00/ Athlete for 3 events or $65.00 for 1 or 2 events* Name of Participant Birth date Trampoline Double Mini Tumbling Fee Panthers Snowflake Classic 2015 Change(s) Request Form CLUB __________________________ CONTACT PERSON ___________________________ Phone#: ___________________________(Home) ___________________________(Cell) Date:_______________________________ Change(s) requested: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ As per the registration technical package, there is a $5.00 fee per change that is completed. Panthers will do its best to accommodate your request. If we are unable to complete the requested change(s) no fee will apply. Head Coach Name:_____________________________________________________ Head Coach Signature:__________________________________________________ (Office use only) Date received:________________________ Response:_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Meet Director’s Signature:________________________________________________________ Panthers Snowflake Classic 2015 Refund(s) Request Form CLUB __________________________ CONTACT PERSON __________________________ Phone#:____________________________(Home) ______________________________(Cell) Date:_______________________________ As per the technical Package states, Refund request(s) will be accepted until December 15th and will be provided after receiving this form, accompanied by a Doctor’s Medical Report. A $30.00 administration fee will be retained on each refund. No Refunds after December 15th. Refund requested for: Athlete’s Name:________________________________ Category:________________________ Reason(s) for refund:____________________________________________________________ ____________________________________________________________ Doctor’s Med. Report included: Yes ( ) No ( ) Office use only: (_________________) Athlete’s Name:________________________________ Category:________________________ Reason(s) for refund:____________________________________________________________ ____________________________________________________________ Doctor’s Med. Report included: Yes ( ) No ( ) Office use only: (_________________) Athlete’s Name:________________________________ Category:________________________ Reason(s) for refund:____________________________________________________________ ____________________________________________________________ Doctor’s Med. Report included: Yes ( Head Coach’s Name: ) No ( ) Office use only: (_________________) _______________________________________ Head Coach’s Signature:_______________________________________
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