Please use this registration form.
SKATING REGISTRATION
Skaters Name: ___________________________________________
Parent(s) Name: _________________________________________
Address:_______________________________________________________
City,State,Zip:________________________________________________________
Phone: ____________________________________________
Email: ____________________________________________
Activity (Please Circle): Learn to Skate or Mom & Tot
Class Time (Please Circle): 6:00 PM or 6:45 PM
Age/Level:____________________________________________
Returning Skater (Please Circle): Yes/No
Skating Experience: _________________________________
***$25.00 Service Fee on all Returned Checks & no refunds***
Liability Waiver
Please read this form Carefully and be aware that in signing up and participating in the program you will be waiving and releasing all claims for injuries sustained arising out of this program, including transportation services, when provided. As a participant in the program I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of injuries, damages or losses which I may sustain as a result of participating in any and all activities associated with such programs. I do hereby release and discharge the and Cornerstone Community Center Inc. and it's officers, agents, volunteers and staff from all claims resulting in injuries or damage and losses due to my participation in the activities provided by these organizations. I further indemnify and hold harmless and defend the named organizations, officers, volunteers and staff all claims resulting from injuries, damages and losses sustained by me and arising out of connection with , or in anyway associated with the activities provided. I have read and fully understand Waiver release of all claims.
Signature:____________________________________Date:____________
Fill out attached registration form & make checks payable to CCC.
Remit to:
Cornerstone Community Center
1640 Fernando Drive, DePere, WI 54115
To get registration materials please call our office at 920-403-2000 or email jgerarden@netnet.net
