DULUTH AREA SPEEDSKATING CLUB
2008 / 2009 SEASON
Skaters Name____________________________________________________________
Address_________________________________________________________________
City_____________State___________Zip_____________Phone ___________________
Email____________________________________School_________________________
Parent / Guardian_________________________________________________________
Gender M / F Age______
Birth date__________________ Novice / Advanced
Physician_________________________________________Phone__________________
Dentist___________________________________________Phone__________________
Hospital for emergency_____________________________________________________
Med. Insurance Co___________________________Principal
Insured________________
Discipline Policy:
DISRUPTIVE OR INAPPROPRIATE BEHAVIOR IS PROHIBITED
Coaches will have latitude in assigning disciplinary
penalties for behavior considered disruptive or inappropriate. Repeat offenses
may result in suspension from the activities. The duration of the suspension
will be determined by the seriousness of the offense. Fees are not refundable.
Waiver:
All participants in the Duluth Area Speedskating Club’s program are exposed to the possibility of physical injury
due to the recreational, athletic, and/or competitive nature of these activities. Each
participant accepts this risk and responsibility as their own by choosing to participate in these activities. By so participating, each participant waives and releases any and all rights and claims for damages that
the participant or his or her heirs or successors may have against Duluth Area Speedskating Club or its personnel, coaches,
directors, USS, GMSA, ASU, UMD, City of Duluth arising out of or resulting from the participants voluntary participation in
the club sport program. I understand that long sleeves, gloves, helmets, long
pants are required on the ice at all times.
I have read the above waiver and certify my compliance with my signature.
Parent / Guardian
Signature__________________________________________________Date__________
Skaters Signature__________________________________________________Date__________
*Starting September
23rd: Club Dues $130/skater ($280/family cap)
*Starting November
4th Club Dues $99 / Skater ($250 / family cap)
This covers all
indoor ice time at UMD (Sept –Oct 12:30-1:30) Nov-Dec 12:30-2:30),
outdoor ice at Chester
Bowl, and coaching.
Please make checks
to: Duluth Area Speedskating Club
Mail to: 35 Toledo St
Duluth, MN 55811
Questions? Call Art and Paula Rannikko 728-6123
Novice / Advanced Division______________
