Renfrew Skating Club
P.O. Box 872 Renfrew, Ontario K7V 4A6
Email *
Skater's First and Last Name *
Please select the program *
Name and Address of Parent/Caregiver that will be on the ice (Must be the same person each week)
Sex *
Date of birth (d/m/y) *
Address *
Postal Code *
Township *
Mother's Name *
Mother's Phone Number *
Father's Name *
Father's 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?
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 (we don't accept credit cards) *
If you answered other please explain?
Fees and Schedule *
Waiver *
A copy of your responses will be emailed to the address you provided.
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