IceWorks Figure Skating
Camp Chill Registration Form

Package Description
 

Indicate your session selections:

No. of Weeks: 

Week 1: June 18 - June 22, 2018
Week 2: June 25 - June 29, 2018
Week 3: July 2 - July 6, 2018
($240 - 4 day week)
Week 4: July 9 - July 13, 2018
Week 5: July 16 - July 20, 2018
Week 6: July 23 - July 27, 2018
Week 7: Aug. 6 - Aug. 10, 2018
Week 8: Aug. 13 - Aug. 17, 2018
Week 9: Aug. 20 - Aug. 24, 2018
Week 10: Aug. 27 - Aug. 31, 2018

Total for all selections:$ 

Refund Policies and Procedures
If an accepted application is withdrawn for any reason up to two weeks prior to the start of the selected camp week, you will receive a refund less a $50 per week administrative fee. If notification of withdrawal occurs within the two weeks prior to the start of the selected week, you will receive a refund less a $100 per week administrative fee. No refunds will be issued for any reason once the selected week has begun.
Contact Information
Skater's Name:
Second Child Discount:   Check this box to request 2nd child/family discount for this skater.
       * Separate application is required for each skater.
       ** Uncheck if only one skater
Skater's Age:     Birth date: 
Parent's/Guardian's Name: (required)
Address:
City: State: Zip:
Home Phone:   Work/Daytime Phone:
Email:

Skating History

  • Has the skater ever been on the ice? Yes No
    If so, how long?

  • Has the skater ever taken a lesson? Yes No
    If so, where?
Present Medical Conditions/Injuries?     Yes     No
If yes, please explain
Doctor's Name:

Doctor's Phone:

Medical Emergency
Hold Harmless Agreement
The above applicant agrees to follow the rules and regulations of IceWorks and releases an holds harmless Iceworks, from any and all injury and all liability, loss or damage.

Assumption of Risk Agreement and Release
Upon entering events sponsored by IceWorks and/or its Agents or Affiliates, I/We abide by the rules of IceWorks as currently published. I/We understand and appreciate that participation or observation of sports constitutes a risk to me/us of serious injury, including permanent paralysis or death. I/We voluntarily knowingly recognize, accept, and assume this risk and release IceWorks, it affiliates, their sponsors, events organizers and officials from any liability thereof.

Medical Release
The above applicant does hereby authorize IceWorks and its employees and agents to make any and all decisions in my absence regarding medical emergency treatment of the above applicant and to sign the necessary hospital release forms in order to obtain medical attention. In case of emergency I can be reached at the number provided in the above form.

Please select the following drop down box to indicate your agreement with regard to the above Medical Emergency and Assumption of Risk statements. Upon submission of this form, user/applicant agrees that he/she is over 18 years of age or is the legal guardian of the person indicated in the "Name" fields of this form.

Comments: Please submit any additional comments that may help us in processing your application.

For Mail or Fax Registration:
If you prefer to reserve via US mail, Click Here to Print This Page or select the Print option from the File menu in the tool bar above. Then complete the form and send it along with your Check, Money Order or Credit Card Authorization for the proper amount to:
IceWorks Skating Complex, 701 Duttons Mill Road Aston, PA 19014
Fax: 610-485-7540; Phone: 610-497-2200 ext. 125