2016-2017 Winter Registration
CanSkate Registration Form
Welcome! To register your skater, read and complete the following information requested and forward this application to our
offices. Please do not forget to sign page two of this form indicating you have read and understood all of our policies. For further
information please feel free to call the club at (613) 860-1334 or visit our website at www.goulbournskatingclub.com.
PROGRAM INFORMATION & QUALIFICATIONS
The CanSkate program is recommended for skater four years old and up who are looking to learn how to skate. The Goulbourn Skating Club maintains
a ratio of 1 coach to a maximum of 10 skaters for each group session.
REGISTRATION OPTIONS



ONLINE: at www.goulbournskatingclub.com and click on Registration to begin your online experience.
BY MAIL: at P.O. Box 178 Stittsville, ON K2S 1A3.
PLACE IN THE GSC DROP BOX: located at the far back west end wall of the Rink “A” seating area at the Goulbourn Recreation Complex,
just outside of the GSC club office.
SKATER REGISTRATION INFORMATION REQUIRED
Skater’s Name (please include middle name)
Date of Birth (M/D/Y)
Email Address
Phone Number
Home Address (including city & postal code)
Known Medical Problems
Mother / Guardian’s Name
Program
Father / Guardian’s Name
Coach
Skate Canada #
Last Badge/Level Passed
Please indicate your program preference by marking an “x” in the appropriate box. Program Qualifications are listed above.
PROGRAM
WKS
LOCATION
DAY & TIME
COST
X
CanSkate
18
Goulbourn Recreation Monday, 5:00pm – 5:50pm
$261
October 3, 2016 – March 6, 2017
- Choice #1 Complex
No Ice: Oct.10, 31, Dec 26, Jan 2, Feb 20
CanSkate
- Choice #2 -
18
CanSkate
- Choice #3 -
21
CanSkate
- Choice #4 -
20
CanSkate
- Choice #5 -
19
CanSkate
- Choice #6 -
19
Goulbourn Recreation
Complex
Monday, 6:00pm – 6:50pm
Richmond Memorial
Community Center
Tuesday, 6:00pm to 6:50pm
Goulbourn Recreation
Complex
Wednesday, 6:00pm to 6:50pm
Richmond Memorial
Community Center
Saturday, 9:30am – 10:10am
Richmond Memorial
Community Center
Saturday, 10:10am – 10:50am
$261
October 3, 2016 – March 6, 2017
No Ice: Oct.10, 31, Dec 26, Jan 2, Feb 20
$305
October 4, 2016 – March 7, 2017
No Ice: Dec 27, Jan 3
$290
October 5, 2016 – March 1, 2017
No Ice: Dec 28, Jan 4
$222
October 1, 2016 – March 11, 2017
No Ice: Oct 22, Nov 26, Dec 24, 31, Feb 11
$222
October 1, 2016 – March 11, 2017
No Ice: Oct 22, Nov 26, Dec 24, 31, Feb 11
SKATE CANADA FEE: A $36.00 fee is applied annually for Skate Canada Programs, covering the skater from Sept 1st - Aug. 31st.
FUNDRAISING FEE: A $90 Fundraising fee with the buyout option of $45. See Fundraising Policy on page 2.
Please make cheque payable to Goulbourn Skating Club
REGISTRANT TOTAL
st
th
1 Payment Details
50% of Fees + Fundraising (+ Late fee if applicable) Dated: September 15 , 2016 Cheque #:
2nd Payment Details Remaining Balance (50% of Fees)
Dated: November 30th, 2016 Cheque #:
P.O. Box 178, Stittsville, ON K2S 1A3
Tel. (613) 860-1334
1 of 2
$
$
$
www.goulbournskatingclub.com
[email protected]
2016-2017 Winter Registration
CanSkate Registration Form
Arena Locations: Goulbourn Recreational Complex, 1500 Shea Road, Stittsville ; Richmond Memorial Community Center, 6095 Perth
Street Richmond.
For late registrations, please allow 5 days for processing in-person/online forms, and 10 days for processing mail-in forms.
Goulbourn Skating Club Volunteer Program
Did you know The Goulbourn Skating Club is organized and operated primarily by
parent volunteers? Our events are a success because our volunteers work together to
ensure they are. Come on out and join our volunteer team. Place a check mark beside
the area you would be interested in volunteering for with The Goulbourn Skating Club
and note your contact information below. Thank you for your help
CanSkate Help
Executive Support
Fundraising
GSC Events
StarSkate Music Player
Special Olympic On-Ice
Parent’s Name:
Contact (Email/Phone Number)
For further information on our volunteer program, please visit the club website at www.goulbournskatingclub.com .
GOULBOURN SKATING CLUB POLICIES (TO NOTE)
Registration Policy: Skaters must register in the category, level and program for which they qualify at the time of registration. Skaters will be notified following their
registration only if there is a change to the times requested in their application for registration. The Club reserves the right to move skaters between levels, depending on
skaters’ abilities. The Club also has the right to change skaters’ ice times depending on the number of registrations received or to cancel hours if registration is insufficient
to continue to hold the session. The Club also has the right to cancel any session if registration is not sufficient or if the City of Ottawa changes or cancels any of the Club’s
ice. In the event that the Club has to change or cancel a session, the skater may be given a refund for the affected session. Each skater will be permitted one (non-Club
imposed) registration change. Each subsequent change will be charged at a rate of $25/event.
Email policy: When you register with the Goulbourn Skating Club, you are providing consent for email communications from the Club to you. These communications will
provide information about the Programs and Services the Club provides to you as a Member. Our Membership runs from September 1st – August 32st annually. In every
email communication, there is an unsubscribe option.
Fundraising Policy: Fundraising is a mandatory activity for all CanSkaters and StarSkaters registering for the winter sessions, up to a maximum of two Fundraising fees per
family. There are two options for fundraising. The first option is to purchase the designated fundraising item and participate in the fundraising activity, decided upon by
the club annually. If the registrant does not wish to participate in the fundraising activity, they are required to pay a buyout fee as an alternative. For further information
on our Fundraising policy, please visit www.goulbournskatingclub.com.
Payment, Refund and Withdrawal Policy: Cheques are to be made payable to “Goulbourn Skating Club”. NSF cheques will be subject to a $25 administration fee.
StarSkate and Primary registrations not received by the due dates indicated on this form may be subject to a $25 late fee.
 For PrePower/CanPower registrants, no refunds will be given after September 1st, annually for fall sessions and November 1st, annually for winter sessions, unless
accompanied by a medical certificate.
 For all other programs, no refunds will be given after the 4th session of the registered program, unless accompanied by a medical certificate. Withdrawals without a
medical certificate, after the start date, will be entitled to a pro-rated refund, less a $25 administration fee.
 For all programs, withdrawals accompanied by a medical certificate, will be entitled to a pro-rated refund. Skate Canada and fundraising fees are non-refundable.
 For further information on our Payment, Refund and Withdrawal Policy, please visit www.goulbournskatingclub.com.
Release Waiver: The registrant agrees that the Goulbourn Skating Club (“GSC”) and its Executive Members, Agents, Directors, Officers, Coaches and Volunteers will not be
held responsible for any accidents or losses, personal injury, loss of or damage to property of any nature, wherever sustained and however caused, and releases the Club
and its Executive Members, Agents, Directors, Officers, Coaches and Volunteers from all claims arising by means of such accident, injury, damage or loss.
Helmet Policy All Skate Canada member clubs and skating schools who offer a CanSkate program must ensure all CanSkate and Adult CanSkate participants up to and
including Stage 5 must wear a CSA approved hockey helmet while on the ice. There will be no exceptions allowed.
Photo Release: Pictures of registered skater may be used in any Club advertising and promotion. (Please Circle one)
IF UNDER 16, SIGNATURE OF PARENT/GUARDIAN
P.O. Box 178, Stittsville, ON K2S 1A3
Tel. (613) 860-1334
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YES
NO
DATE
www.goulbournskatingclub.com
[email protected]