2019-2020 Synchroettes Tryout Clinics Registration Form
*Moves-in-the-Field levels are as of March 1, 2019. No exceptions.

• All sessions will be held at the Richard J. Codey Arena, 560 Northfield Ave, West Orange, New Jersey 07052.

• Registration will be available on our website at http://www.synchroettes.com/tryouts.

• Fees (includes all team placement clinic sessions)
• Clinic #1 - $125
• Clinic #2 or Clinic #3 - $250

• Skaters are required to attend all dates for the clinic they register for. If you are unable to attend the clinic which applies to your age/MIF level, and are still interested in joining our teams, please email: the.synchroettes@gmail.com

• Skaters are carefully evaluated by our coaching staff not solely by their Moves-in-the-Field level. Our coaching staff evaluates skater’s skating skill, team skills, focus, attitude and performance.

• All skaters please wear black pants and black fitted layers. Girls please pull hair back neatly into a bun.

• Registration closes on March 10 2019.

• Refunds or credits will not be issued for any clinic missed dates.

Questions? Please email the.synchroettes@gmail.com

Skater Information
Skater's First Name *
Your answer
Skater's Preferred First Name (if any)
Your answer
Skater's Last Name *
Your answer
DOB *
mm/dd/yyyy
Your answer
Skater's Cell *
xxx-xxx-xxxx If skater does not have their own cell phone, type NONE.
Your answer
Skater's Email *
If skater does not have their own email address, type NONE.
Your answer
USFS # *
Please enter "NONE" if skater does not have a USFS #.
Your answer
Home Skating Club *
Please enter "NONE" if skater does not have a home skating club.
Your answer
Skater's Grade in School (for the 2019-2020 school year) *
Skater's School (for the 2019-2020 school year) *
Your answer
2018-2019 Synchroettes Skating Team *
If you skated on a team other than the Synchroettes in 2018-2019, please provide the team/organization name and level skated:
Your answer
Skater Medical Information
If your skater uses an inhaler, do you give permission to keep the inhaler with your skater at the team activities and to use it as needed? *
If your skater uses an Epi-Pen, do you give permission to keep the Epi-Pen with your skater at the team activities and to use it as needed? *
Does your skater have any allergies? *
If yes, please explain your skater's allergies (e.g., foods, medications, animals or environmental factors), the severity of your skater's allergic reaction and any symptoms.
Your answer
How many concussions has your skater had in their lifetime? *
How many concussions has your skater had in the past 12 months? *
Does your skater have a medical condition or has your skater had an injury (other than a concussion) in the past 12 months? *
If yes, please explain the medical condition or injury.
Your answer
Health Insurance Carrier Name *
Your answer
Health Insurance Policy Number *
Your answer
Health Insurance Subscriber Name *
Your answer
Health Insurance Employer Name *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone # *
xxx-xxx-xxxx
Your answer
Pediatrician's Name *
Your answer
Pediatrician's Phone # *
xxx-xxx-xxxx
Your answer
Pediatrician's Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Dentist's Name *
Your answer
Dentist's Phone # *
xxx-xxx-xxxx
Your answer
Dentist's Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Parent Information
- Please provide contact information for at least one parent.
- If both parents want to be included in Synchroettes communications, please provide Parent 2 contact information.
Parent 1's Name *
Your answer
Parent 1's Cell Phone # *
xxx-xxx-xxxx
Your answer
Parent 1's Email *
This will be the primary email used by the Synchroettes. This email may also be shared with synchronized skating competition organizers for the purpose of completing on-line skater waivers.
Your answer
Parent 1's Medical Training
Please check all that are applicable
Parent 2's Name
Your answer
Parent 2's Cell Phone #
xxx-xxx-xxxx
Your answer
Parent 2's Email
Your answer
Do you want to include Parent 2's Email in any Synchroettes Google Group emails? *
Parent 2's Medical Training
Please check all that are applicable
Volunteer Interests *
Please check the Synchroettes Volunteer Opportunities in which you are interested in participating for the 2019-2020 season.
Required
501c3 Matching: Does your company provide matching funds for donations to charities? *
501c3 Matching Employer
If yes, please provide the employer name(s) that provide matching funds.
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone # *
xxx-xxx-xxxx
Your answer
Skater USFS Test Levels Passed (as of March 1, 2019)
USFS MIF (Move-in-The-Field) Passed (as of March 1, 2019), Select "Not Tested" for no test. *
USFS Free Skate Passed (as of March 1, 2019). Select "Not Tested" for no test. *
USFS Dance Passed (as of March 1, 2019). Select "Not Tested" for no test. *
# of Dances Passed for this Level
Please indicate # of dances passed at this level
Team Placement Clinics
ELIGIBILITY

- Clinic #1

• All ages
• No test Moves-in-the-Field through passed Pre-Preliminary Moves-in-the-Field*

- Clinic #2

• Skaters 12 and under as of July 1, 2019
• Passed Preliminary Moves-In-the-Field and above*

- Clinic #3

• Ages 13 and above as of July 1, 2019
• Passed Novice Moves-in-the-Field and above*
• Passed Preliminary through Intermediate Moves-in-the-Field*
*Skaters will be grouped accordingly*

* Moves-in-the-Field Test levels are as of March 1, 2019. NO EXCEPTIONS.

Note: Skaters without synchro experience but having passed Moves-in-the-Field Tests should email the.synchroettes@gmail.com with Moves-in-the Field test level and skating experience for direction on registration group.

Which clinic your skater be attending? *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service