Hampton Speed Skating Club 2018-19 Registration Form
Welcome to the Hampton Speed Skating Club. Please enter the information for registering your skater.

You will need to fill out one form per skater.

First Name *
Your answer
Last Name *
Your answer
Gender *
Required
Program registering in *
Please register in the group you were in last season unless you received an email to change groups.
Required
Street Address *
Your answer
Town *
Your answer
Postal Code *
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Email Address *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age as of June 30, 2018 *
Your answer
Medicare number *
Your answer
Medicare Expiry date *
Enter the day as the first (1)
MM
/
DD
/
YYYY
Allergies *
Your answer
Parent(s)/Guardian(s) Name(s) *
Your answer
Emergency Contact *
Your answer
Emergency phone number *
Your answer
Family Doctor name *
Your answer
Family Doctor phone number *
Your answer
I acknowledge that photos of my child, taken at club skating events, may be posted on the club bulletin board and website and that no personal information will be disclosed on the website without the parent/guardian prior permission. *
By checking the box below you agree to the above statement.
Required
HSSC is a volunteer run organization and your help is greatly appreciated. Please check the boxes below if you can help with these jobs.
How would you like to pay your fees? *
Required
Do you require skates? *
We have a speed skate rental program. You can rent boots & blades, just boots or just blades.
Required
Speed Skate Canada Number - if known
Your answer
Other notes
Please tell us if you have any other concerns or issues we should be aware of.
Your answer
Cheques are payable to Hampton Speed Skating Club
Please mail cheques to:
Hampton Speed Skating Club
c/o Charles MacNeil
493 Bonney Road
Canada NB E5N 7B3
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