Brant Skating Club - Skate Canada Registration and Safety Contacts

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* 1. Please enter the Skater's name and home residence/mailing address:

Name *

Street Address *

Address 2 *

City/Town *

State/Province *

ZIP/Postal Code *

Email Address (parent/guardian email if applicable)

Phone Number (parent/guardian email if applicable)

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* 2. What is the skater's date of birth?

MM / DD / YYYY (month/day/year)

Date

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* 3. What gender does the skater identify with?

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* 4. What skating program will the skater be participating in?

CAN Skate

POWER Skate

STAR Skate

TOT and Parent Skate

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* 5. What is the skater's current CAN Skate level?

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* 6. What is the skater's current POWER Skate level?

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* 7. What is the skater's current STAR skating level?

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* 8. What is your home club?

Brant Skating Club

Other (please specify)

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* 9. Who is your skating coach?

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* 10. Please enter your Parent/Guardian/Emergency contact information:

Parent/Guardian Name *

Street Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Parent/Guardian Email Address *

Parent/Guardian Phone Number *

Brant Skating Club - Skate Canada Registration and Safety Contacts

Question Title

* 1. Please enter the Skater's name and home residence/mailing address:

Question Title

* 2. What is the skater's date of birth?

Question Title

* 3. What gender does the skater identify with?

Question Title

* 4. What skating program will the skater be participating in?

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* 5. What is the skater's current CAN Skate level?

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* 6. What is the skater's current POWER Skate level?

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* 7. What is the skater's current STAR skating level?

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* 8. What is your home club?

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* 9. Who is your skating coach?

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* 10. Please enter your Parent/Guardian/Emergency contact information:

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* 11. Please add any important note we should be aware. Ex. Allergy or Medical conditions.