Last Name _____________________ Phone No. (Home) _______________ (Emergency ) ________________

Address __________________________________ City __________________________ Zip _____________

Email Address _______________________________________________________________

Refunds prior to the first day

Full Payment: 75% refund less a $10 administrative fee.

Refunds on or after the first day

A full refund less a $10 administrative fee will be given to entry level participants if the child refused to participate during the first day. This applies only to Tot 1 Beg classes.

Full Payment: 50% refund less a pro-rated per class fee for each class that has taken place up to the date of notification.

Waiver and Release of All Claims
Please read this form carefully and be aware that in registering yourself or your minor child/ward for participation in this activity, you will be waiving and releasing all claims for injuries you or your child/ward might sustain arising out of this and all future activities at Twin Rinks Ice Pavilion, Inc.
"I recognize and acknowledge that there are certain risks of serious injury to participants in this activity and I agree to assume the full risk of any injuries, damages or loss regardless of severity which I or my child/ward may sustain arising out of this and all future activities.  I agree to waive and relinquish all claims I or my child/ward may have arising out of this and all future activities against Twin Rinks Ice Pavilion, Inc. and its officers, directors, shareholders, agents, servants, and employees.  I do hereby fully release and discharge Twin Rinks Ice Pavilion, Inc. and its officers, directors, shareholders, agents, servants, and employees from any and all claims from injuries, damages or loss which I or my child/ward may have or which may accrue to me or my child/ward arising out of this and all future activities.  I further agree to indemnify and hold harmless and defend Twin Rinks Ice Pavilion, Inc. and its officers, directors, shareholders, agents, servants and employees from any and all claims resulting from injuries, damages and losses sustained by me or my child/ward, and arising out of, connected with, or in any way associated with this and all future activities.  In the event of an emergency, I authorize Twin Rinks Ice Pavilion, Inc's. officials to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my or my child/ward's immediate care and agree that I will be responsible for full payment of any and all medical services rendered"

I have read and fully understand the above program details, payment requirements and waiver and release of all claims.
I agree to pay the credit card charges charged to the following credit card: 

Discover  MC  Visa    _________    _________    _________    _________  CVVC ____ Expires ___/___/___

Signature ____________________________________________     Date ________________
Signature required of all participants 18 years or older, parent or guardian signature for those under 18.

1500 Abbott Ct. · Buffalo Grove, IL  60089 · (847) 821-RINK · fax: (847) 821-RINX · www.TwinRinks.com