KWSSSC Registration Form 2019-2020
This is the official registration form for the Kitchener Waterloo Sertoma Speed Skating Club (KWSSSC).
We ask that you please take time to fill out the form accurately and thoroughly.
This form must be filled out once for each Member of the KWSSSC.
Email address *
Please Note: the Email Address provided above should be the preferred email address of the main contact of the Family to which the KWSSSC Member belongs (Note: if the Member is 18 years of age or younger, the email address submitted here MUST belong to a Parent or Guardian and MUST NOT belong to the youth Member)
KWSSSC Member's Name *
Your answer
Name of the person filling out this Registration Form *
Your answer
KWSSSC Member's Birthdate *
MM
/
DD
/
YYYY
KWSSSC Member's age as of July 1, 2019 *
Your answer
KWSSSC Member's Street Address (please include Unit number if applicable) *
Your answer
KWSSSC Member's City of Residence *
Your answer
KWSSSC Member's Postal Code *
Your answer
KWSSSC Member's Preferred Phone # *
Your answer
KWSSSC Member's Assigned Skater Group for 2019-2020 *
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