Skater's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

You must be the parent or legal guardian to register a child under 18 years old. *

You are this person's parent or legal guardian.

Name *

First Name

Last Name

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I would like to receive periodic IceLiners news and updates via email.

Cell Phone *

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Home Phone

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Please read the following carefully. *

On behalf of my child, I accept any and all risks associated with his/her attendance and participation in the Clinic and its activities. I understand that my child should not attend the Clinic if he/she is not healthy. I understand that my child must abide by IceLiners Synchronized Skating Team policies and the instructions of the staff. In the event that I cannot be contacted in an emergency, I hereby grant IceLiners Synchronized Skating Team (IceLiners) permission to give immediate treatment and/or take my child to a hospital emergency room. Permission is hereby granted for photographs and/or videos to be taken of my child at the Clinic and IceLiners has the right to utilize in IceLiners or Ice Line, Inc. brochures, videos, slideshows, website, social media and other skating materials. Knowing these facts and in consideration for your accepting my child’s registration, I, for myself, my child attending the Clinic, and anyone else who might claim on my or my child’s behalf (“I”), hereby agree that neither IceLiners nor IceLiners Partners (Ice Line, Inc.) are responsible for any and all accidents, injuries, and/or medical or dental expenses arising from my child’s participation in the Clinic and, accordingly, I covenant not to sue, and waive, release and discharge IceLiners and IceLiners Partners (Ice Line, Inc.), and anyone working on their behalf from any and all claims of liability or expenses of any kind or nature whatsoever arising out of or relating to my child’s participation in the Clinic. I have carefully read all of the information in this application form and agree to all conditions.

I agree to the IceLiners Synchronized Skating Team Release of Liability.