Wallaceburg Skating Club CanSkate Registration 2020-2021 Question Title Question Title * 1. Name: Question Title * 2. Date of Birth (dd/mm/yy): Question Title * 3. Parent/Guardian Name: Question Title * 4. Street Address, Email & Phone Number Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Picture for reference only. Session days and times are subject to changes depending on interest/numbers. Question Title Question Title * 5. Select your choice below: CanSkateTuesday only: 5:50pm - 6:20pm CanSkateThursday only: 6:15pm - 6:45pm CanSkate (Both Nights)Tuesday: 5:50pm - 6:20pmThursday: 6:15pm - 6:45pm Question Title * 6. I agree to have photos and/ or name of above skater published in our newsletter/ program/ Facebook. Yes No Done