Registration for IceLiners Free Synchro Clinic

Skater's Information
Skater's Name *
Skater's Name
Date of Birth *
Date of Birth
Gender *
Address *
Team Name, Levels and Number of Years. (Please write "None" if this will be your first time. Welcome!)
You must be the parent or legal guardian to register a child under 18 years old. *
Parent/Guardian Information
Parent/Guardian Name *
Parent/Guardian Name
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Parent/Guardian Cell Phone *
Parent/Guardian Cell Phone
Parent/Guardian Home Phone
Parent/Guardian Home Phone
Waivers and Agreements
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.
By entering my name below, I assert that I have reviewed and agree to all the waivers and agreements I selected above.