Power Skating Registration
P.O. Box 872 Renfrew, Ontario K7V 4A6
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Email *
Skater's Last Name *
Skater's First Name *
Please select the level your child will be playing during the 2021/22 season *
Sex *
Birthday D/M/Y *
Address *
Postal code *
Township *
Mother's Name *
Phone Number *
Father's Name *
Phone Number *
Emergency Contact (other than parent) *
Emergency Contact Phone Number: *
Does your child suffer from allergies? *
Does your child carry an epipen? *
Does your child have special needs? *
If you answered yes, please explain
The Renfrew Skating Club may use photos for publicity, such as the website and newspaper to generate awareness of our sport and acknowledge skaters achievements. Unless you select "OPT OUT", we may include your skater's name and image. *
Method of Payment *
If you answered *Other, please specify
Times: *
Fees and Schedule *
Please check that you understand: *
Waiver *
A copy of your responses will be emailed to the address you provided.
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