Skater Name:

First Time Lessons    Previous Lessons

                                            Last Test Passed:

                                            Session #/Date:

Birthdate:

Parent/Guardian Name(s):

Address:

City:   Zipcode:

E-mail Address:

Parent/Guardian Permission.  By checking this box your are giving your consent for the above named child to participate in the Cedar Valley Figure Skating Club Learn to Skate Classes.  You also understand that the Young Arena, City of Waterloo, Waterloo Leisure Services, and the Cedar Valley Figure Skating Club will not be held responsible for any injuries or accidents that orccur while participating in any of our events/classes.

Class Time Choice:

Monday    5:30-6:20 pm    July 30-August 27, 2007     $50.00

Monday    5:30-6:20 pm    July 30-August 27, 2007     $55.00

                                           (Parent & Me Class)

Class Level Choice:

Snowplow Sam 1 Snowplow Sam 2 Snowplow Sam 3 Basic 1 Basic 2 Basic 3 Basic 4 Basic 5 Basic 6 Basic 7 Basic 8 Adult

                        Total Fees: 

Payment Options:

Mail Prior to Class Start Date

Pay on First Day of Class

Payments will be accepted in the form of Cash, Check or Money Order Only.  No Credit/Debit Cards Please.

Mail Payments to:

CVFSC Learn To Skate

P.O. Box 1052

Waterloo, IA  50704