2019 Show Registration Form

SHOW REGISTRATION

Event Date: June 22, 2019
SKATER INFORMATION:
Skater's Name

First NameLast Name
Is skater under the age of 18?
Parent/Guardian Name

First NameLast Name
Skater's Gender
Birth Date

MonthDayYear
Age
Height
SKATING BACKGROUND:
Primary Rink

Other
Skater is currently taking....
Current group lesson instructor
Current class name/level
Private lesson coach
Skating Category
Highest Basic Skills Level Passed
Highest Free Skate Level Passed
Highest Freestyle Level Passed
Favorite Jump
Jump Rotation Direction
Favorite Spin
Favorite Artistic Element
Highest Moves in the Field Level Passed
CONTACT INFORMATION:
E-mail (required for all event communications)
Preferred Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMERGENCY CONTACT

First NameLast Name
Emergency Contact Phone #
Format: (000) 000-0000.
Relationship to Skater
PAYMENT:

Registration Fee

Registration$150.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

ACKNOWLEDGEMENT:
PHOTO RELEASE
WAIVER / TERMS & CONDITIONS:
Additional Comments
Should be Empty: