2017 Spring Registration
StarSkate 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
 Senior: Must have passed two of the following: Star 5 Skills, Star 5 Freeskate (Elements & Program), Star 5 A&B Dances
 Intermediate: Must have passed two of the following: Star 3 Skills, Star 3 Freeskate (Elements & Program), Star 3 A&B
Dances
 Junior: Must have completed Canskate Stage 6 and be able to work independently and retain the services of a private
coach
Synchro Skills (Saturday): This session will focus on edges, turns and steps as well as building power, speed, conditioning
and synchronicity. Basic stroking skills are a key development area in addition to turns and form. Exercises and drills will be
done both individually and in groups to allow skaters to improve their own skills and reinforce team skills. All skaters are
welcome, whether you are on a synchro team or interested in joining one, this session will be very beneficial to all skaters.
Skaters should, at minimum, have completed Stage 5 Canskate.
The 10am session is suitable for skaters who were on our Elementary or Juvenile teams this past season as well as skaters
trying synchro that are 10 years of age or older. The 11am session is suitable for skaters who were on our Beginner 2 team
this past season as well as skaters trying synchro for the first time under the age of 10. The Goulbourn Skating Club
reserves the right to move skaters as needed between the 2 hours based on registration numbers.
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 arena seating area at the Goulbourn
Recreation Complex, just outside of the GSC club office.
REGISTRATION DEADLINE IS FRIDAY MARCH 10, 2017
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 Skills Test Passed
Last Freeskate Test Passed
Last Dance Test Passed
Home Club
 P.O. Box 178, Stittsville, ON K2S 1A3
 613.860.1334
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[email protected]
2017 Spring Registration
StarSkate Registration Form
Please indicate your program of preference by marking an “x” in the appropriate boxes.
Program qualifications and session descriptions are listed on page 1.
DATE/LOCATION
Monday (4
Weeks)
Goulbourn
Recreation
Complex
April 3, 10, 17, 24
TIME
LEVEL / SESSION
5–6pm
Jr/Int Freeskate
6–6:20pm
WEEK
1
WEEK
2
WEEK
3
WEEK
4
COST
PER
x # WEEKS
TOTAL
$18.25
$
Jr/Int Skills & Dance
$6.25
$
6:30–7pm
Int/Sr Skills & Dance
$9.25
$
7–7:50pm
Int/Sr Freeskate
$15.25
$
8– 8:50pm
OPEN
$15.25
$
Tuesday (4
Weeks)
7 – 8am
OPEN
$18.25
$
GRC
8 – 8:50am
OPEN
$15.25
$
April 4, 11, 18, 25
5– 5:20pm
Junior Skills/Dance
$6.25
$
5:20–
6:20pm
6:30–
6:50pm
7– 7:50pm
Jr Freeskate (& Adv
Canskate)
$18.25
$
Int/Sr Skills & Dance
$6.25
$
Int/Sr Freeskate
$15.25
$
Wednesday (4
Weeks) GRC
3– 3:50pm
Int/Sr OPEN
$15.25
$
April 5, 12, 19, 26
4– 4:50pm
OPEN Freeskate
$15.25
$
Friday (3 Weeks)
3– 4:20pm
OPEN
$24.35
$
GRC
4:20–
4:50pm
OPEN Dance/Skills
$9.35
$
April 7, 21, 28
5– 5:50pm
OPEN Freeskate
$15.70
$
6– 6:50pm
Jr Freeskate (& Adv
Canskate)
$15.70
$
Saturday (5
Weeks) GRC
10–
10:50am
Synchro Skills
$100.00
$
April 1, 8, 15, 22,
29
1111:50am
Synchro Skills
$100.00
$
DISCOUNTS: If over $210.00 in program fees, deduct 10%.
($
SKATE CANADA FEE: A $36.00 fee is applied annually for Skate Canada Programs, covering the applicant from Sept.
$
1st until Aug. 31st.
LATE FEE: A $25.00 late fee is applied if the registration is received after March 10, 2017
Please make cheques payable to Goulbourn Skating Club
Payment Details
Total Fee payable
Dated: March 10, 2017
)
$
REGISTRANT TOTAL
$
Cheque
#
Please be aware, unless otherwise noted, all spring programming will begin the week of April 1, 2017 and ends April 30, 2017.
Arena Location: Goulbourn Recreational Complex, 1500 Shea Road, Stittsville
 P.O. Box 178, Stittsville, ON K2S 1A3
 613.860.1334
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2017 Spring Registration
StarSkate Registration Form
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.
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. All registrations not received by the due dates indicated on this form will be subject to a $25 late fee.
 For all 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 with a medical certificate, will be entitled to a pro-rated refund. Skate Canada & fundraising fees are nonrefundable.
 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.
Photo Release: Pictures of registered skater may be used in any Club advertising and promotion. (Please Circle one) YES
NO
IF UNDER 16, SIGNATURE OF PARENT/GUARDIAN
 P.O. Box 178, Stittsville, ON K2S 1A3
 613.860.1334
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DATE
www.goulbournskatingclub.com
[email protected]