Glissad Skating Club Annual Holiday Ice Show 2014 Sunday, December 28, 2014 at 3:45 pm; Iceland Ice Rink Sanctioned by US Figure Skating Tickets to our exciting show will be available at the door the day of the show! Tickets will be $5.00 each and children under 3 are free! REGISTRATION Glissad Skating Club Members - $20.00 per program Non-members (Associate, Learn to Skate, etc) - $30.00 per program Group numbers (2 or more skaters) - $15.00 per program Skater Name __________________________________________________________________________ Email ____________________________________________ Phone # ____________________________ USFSA level _______________________________ Coaches name_______________________________ Music Program #1 ______________________________________________________________________ Music Program #2 ______________________________________________________________________ ADS – BLACK AND WHITE ONLY Want to place a shout out in our Holiday Show Program? We are offering the following ads! ½ page ad - $20.00 ¼ page ad - $10.00 2 line shout-out - $5.00 PAYMENT Please return this registration form and payment to your coach or any Learn to Skate Instructor by Saturday, December 6, 2014 (deadline enforced). In addition, the program/skating order is FINAL and there will be no further changes made to the schedule. Glissad Skating Club Members - #of programs _____ x $20 = $_____ Non-members (Associates, LTS, etc) - # of programs _____ x $30 = $_____ Group programs (2 or more skaters) - # of programs _____ x $15 = $ _____ ½ page ad (please email ad to Jenn Schaffener) - # of ads _____ x $20 = $ _____ ¼ page ad (please email ad to Jenn Schaffener) - # of ads _____ x $10 = $ _____ 2 line shout out (please email ad to Jenn Schaffener) - # of ads _____ x $5 = $ _____ FOR MORE INFORMATION Eleanor Reiss Eleanorskate8@yahoo.com 732-489-2930 Donna Console pinksk8s@aol.com 609-220-8188 Jennifer Schaffener jschaffener@icloud.com 609-712-1077 Accident/Liability/Photo Release: I, or my son/daughter or child over whom I have legal custody, wish to participate in classes/activities organized by Glissad Skating Club. I agree to release Glissad Skating Club, and/or their members, employees, agents, representatives, sponsors, affiliates and/or subsidiaries, from all claims, actions, causes of action or damages suffered by me or my son/daughter or child over whom I have custody for any loss or injury resulting from participation in the aforesaid classes/activities. I understand that by participating in a Glissad Skating Club program, I or my child could be injured, die and/or suffer property damage. Regardless of bodily injury, death or property damage sustained by me or my child from participating in a Glissad Skating Club program, I agree not to sue, or allow others to sue on my behalf. I understand that photographs and/or video of me or my child may be taken during the show rehearsals and performances, and that these images may be used for promotional purposes. Parent Signature ________________ Skater Signature __________________ Date _______________