Skater's Name Your email Phone number Monthly Option (Select all applicable options) R400 (1 lesson per week)R720 (2 lessons per week)Private (GNFSA Members)Private (NON GNFSA MEMBERS)Coach Emergency contact (Name, Surname, and Relation) Emergency Contact Number (Please use an alternative number from the main phone number provided above) SAFSA nr (if you are a GNFSA member) Parent's Name Skater's Date of Birth Ethnicity BlackWhiteColoredIndianAsianOther Disability YesNo I hereby authorize Production et al (PTY) to photograph and record (on film, digital, video, tape, or otherwise) to incorporate same into the Evolution On Ice or other program or not; to use and to license others to use such recordings and photographs in any manner or media whatsoever, including without limitation unrestricted use for purposes of publicity, advertising and sales promotion; and to use my name, likeness, voice, biographic or other information concerning me in connection with the Evolution On Ice, commercial tie-ups, merchandising, and for any other purpose. I hereby consent to my child or myself participating, as Evolution On Ice Member and indemnify the Gauteng North Figure Skating Association, The Ice Company, the respective clubs and the Coaches against any claims that may arise. I accept that all reasonable precautions will be taken to ensure the safety and welfare of my child/myself. I accept responsibility for the payment of medical and or hospital accounts, where applicable should an injury be sustained for whatsoever reason during on or off-ice activities. I also declare that the South African Figure Skating Association (SAFSA), Gauteng Figure Skating Association, The Ice Company, the respective clubs and the Coaches cannot be held liable and are indemnified against the loss of any personal articles including but not limited to clothing / skates / skating accessories. I hereby understand and agree to the indemnity above and the indemnity of The Ice Company and on the website of www.gnfigureskating.co.za Submit
