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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 robert@panthersgymnastics.ca
(204) 232-4244 helenedesmarais1@gmail.com
$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:_______________________________________