Skater's Name *

First Name

Last Name

Skater's Date of Birth *

MM

DD

YYYY

Skater's Gender *

Female

Male

Other

Parent/Guardian's Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

U.S. Citizen? *

Yes

No

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Membership Type *

First Family Member $142.00

Subsequent Family Member $117.00

Introductory Member $115.00

Subsequent Introductory Member $107.00

Collegiate Member $180.00

Associate Member $60.00

WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT *

In consideration of participating in Chesapeake Figure Skating Club of Maryland (“CFSC”) activities, I represent that I understand the nature of figure skating activities (“activity”) and that I am qualified, in good health and in proper physical condition to participate in such “activity”. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the “activity”. I fully understand that this “activity” involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the “activity”, the conditions in which the “activity” takes place, or the negligence of the “releasees” named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I incur as a result of my participation in the “activity”. I hereby release, discharge, and covenant not to sue the Chesapeake Figure Skating Club of Maryland, United States Figure Skating, it’s directors, officers, administrators, sponsors, volunteers, agents, employees, staff, instructors, trainers, other participants and if applicable, owners and lessors of premises on which the “activity” takes place (each considered one of the “Releasees” herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “releases” or otherwise, including negligent rescue operations; and I further agree that if, despite this release, waiver of liability, and assumption of risk, I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the releases from any loss, liability, damage, or cost which any may incur as the result of such claim. The Chesapeake Figure Skating Club of Maryland has the right, but not the obligation, to provide rules, regulations and/or ice monitors for Club Ice. We hereby acknowledge that the Chesapeake Figure Skating Club of Maryland shall not be responsible for the supervision of the members at Club Ice. I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.

I have read, understand, and agree to the terms listed above.

Photo Release *

Do you give CFSC to release photos of current member?

I Agree

I DO NOT Agree

Payment *

All fees are payable via Venmo. Please submit payment to @CFSCMD and label it with your skater's full name and membership type. Payment cannot be processed without this information. **Membership may also be paid by cash or check. Payments can be left on Jodie Timmins' desk at Ice World in an envelope.**

I understand that my membership is not final until payment is made. I understand it may take 5-7 business days to process my membership and payment is non-refundable.