Ice Oasis

Can be Faxed 650-364-8634 or mailed to: Nazareth Ice Oasis attn: Susan Blaisdell, 3140 Bay Road, Redwood City, CA 94063

Student Name: _________________________ Birth date: ____________ Age: _______

 Parent's Name: ________________________________ E-Mail: _________________ 

Address: ____________________________________ City: __________________ Zip: _____

 Home Phone: ______________________ Emergency / Cell Phone: ______________________

 ISI Test Level: ________________ USFS Test Level: ________________ T-Shirt Size: _______

 Food Allergies?: _________________________

WAIVER AND RELEASE FORM

I, the undersigned, do hereby voluntarily submit my application to enroll in the Nazareth Ice Oasis Skating School. I agre to follow all Nazareth Ice Oasis Rink Rules. I realize that protective gear is designed to reduce the risk of injury, but will not prevent all injuries while skating. There is no guarantee for my/my child's safety. I understand that there are risks involved with ice skating and that injuries are common and can be serious, even if I/my child skate(s) in control and wear(s) protective gear. I freely assume these risks and release Nazareth Ice Oasis, Inc., employees and coaches from any liiability, claim or suit out on my/my child's participation in ice skating. I/my child skate(s) at my/my child's own risk. Failure to comply with the Rules of Nazareth Ice Oasis may result in my removal from the Ice Rink with no refund. I fully understand that Nazareth Ice Oasis may change the instructional time or cancel a class due to insufficient enrollment. I fully understand that Nazareth Ice Oasis is not required to refund to me any portion of my registration or program fee unless cancellation notice is received by the Nazareth Ice Oasis Skating Director prior to first class meeting. I fully understand that if I or my child cannot attend a regular lesson scheduled by the school, a make-up lesson may be provided, but Nazareth Ice Oasis is under no obligation to provide for such make-ups. Missed classes may only be made up prior to the last day of the skating school series in which I or my child is enrolled.

I have read and understand the foregoing release.

Parent/Guardian Signature: ______________________________ Date: ___________

SUMMER CAMP -- Indicate the camp session you wish to attend:

• _____ Beginner Camp Week 1: (June 16-20); $225 -- deadline 6/6
• _____ Beginner Camp Week 2: (August 4-8); $225 -- deadline 7/25
• _____ Both Sessions of Beginner Camp; $375
• _____ Freestyle Camp -- Both Weeks (July 21-August 1); $700
• _____ First Week only (July 21-25); $425 -- deadline 7/7
• _____ Second Week only (July 28-August 1); $425 -- deadline 7/7
• NAZARETH ICE OASIS CLUB MEMBERS RECEIVE 25% DISCOUNT; CLUB MEMBER'S CHILDREN RECEIVE 10% DISCOUNT

Total Due: ____________ 

Payment Information:

• Check # ___________ (Note: A service Charge of $25 is due for all returned checks)
• Credit card (visa, mastercard, discover): Acct #__________________________Exp. date_______ 
•  I give Nazareth Ice Oasis permission to charge the above fees on this charge card;
•           Signature: __________________________________ Date: _________