SnoKing Kirkland Ice Arena Fiesta Skate Saturday, March 28, 2015 Name: E-mail: Address: Contact # City/State/Zip USFS/Basic Skills # Skaters Birthdate: Highest Level Age: Basic Level Male/Female FreeSkate Level USFS Level Passed: Please Circle or Highlight the event and the division you are entering: Events Offered Basic Program Free Skate 1 -6 Well-balanced Free SkateShowcase/Artistic Events Snowplow Sam Free Skate 1 No - Test Basic 1/2 Basic 1 Free Skate 2 Pre-Preliminary Basic 3/4 Basic 2 Free Skate 3 Preliminary Basic 5/6 Basic 3 Free Skate 4 Basic 4 Free Skate 5 Adult Levels Free skate 1 2 3 4 5 6 (Circle level) Basic 5 Free Skate 6 Adult 1 Beginner/High Beginner Adult 2 No Test Basic 6 Basic 7/8 Basic 7 Test Track Adult 3 Pre-Preliminary Basic 8 Beginner Adult 4 Preliminary High Beginner Adult 5 Adult 1/2 Pre-Preliminary Adult 6 Adult 3/4 Preliminary Adult Pre-Bronze Adult Adult Bronze Exhibition Only/List Current Level / Pre-Bronze or Adult 5/6 Bronze 1) I/we the parents of _______________________ do hereby give my/our consent to any authorized physician to perform such medical services as may be necessary because of my/our son or daughter in the Kingsgate Ice Arena activities. I/we do further release, absolve, indemnify and hold harmless the ice arena, officers, board members, coaches, supervisors and any authorized physician, any or all of them. I/we hereby waive all claims against the aforementioned parties or any other persons appointed by them or any authorized physician. I/we understand the term "authorized" physician means not only our own physician listed below but, any other licensed, practicing physician who is called to perform the required medical services. Parent/Guardian Signature: ____________________________________________________ Instructors Signature: _________________________________________________________ Mail or deliver to: SnoKing Kirkland Ice Arena Attention : Fiesta Skate 2014 14326 124th Avenue N.E, Kirkland, WA 98034 [email protected] [email protected] Fees & Payments First Event Fee $30.00 $ 2nd Event Fee $15.00 $ Practice Ice $ $ 10.00 20 Minutes Total Enclosed $ $ Entries & Practice Ice forms & Payment due before March 1, 2015 There are no refunds Please make checks out to SnoKing Ice Arena Practice Ice Registration Form on Reverse Side of Entry low