Return Completed Form with payment to:
West Zone Board Office, c/o NWLC
1127 Arnason Street North
Regina, Saskatchewan  S4X 3V4


1127 Arnason Street North
Regina, SK  S4X 3V4
Phone:  306-791-0226

                      LEARN TO SKATE  – REGISTRATION FORM

Location of Class:                                                                                                                                             

 Day:                                                          Date:                                          Time:                                           

 Child’s Name:                                                                 Age:          Day           Month            Year                

 Address:                                                                                              Postal Code:                                        

 Phone:  Home:                                                             Work./Cell:                                                                   

 Community you reside in:                                                           Community Membership #                             

 Signature of Parent/Guardian:                                               Print Name:                                                         

 Email: (print clearly)                                                                                                                                

                                                       SUPPLEMENTARY INFORMATION

  1. Can your child:  (please check if yes)         Stand on Skates                 Skate the width of the rink without falling

                                                                Get up on his/her own            Stop                 Skate without assistance

  2.   Has your child ever taken a Learn To Skate Program before?          No         Yes     If yes, how many times?                               
  3.    Would you be willing to help with the first 1 or 2 lessons, until your child can get up on their own?                     Yes                  No

Payment is required at time of registration. No notification will be given if you are registered in the class. Unless you are phoned
about class changes/cancellation – show up for the first scheduled Class.  Please make cheques payable to West Zone Board.

REFUND POLICY: If a Program is cancelled by the Zone Board – the full fee will be refunded. Registrants wishing to withdraw from a
Program must make request in writing before the 3rd meeting of the Program & include their receipt. Refunds [minus $10.00 Administration
Fee] may be issued as a “Letter of Credit” towards a West Zone Board Program [at the executive’s discretion] expiring 1 year from
issue date. Refund requests received after the 3rd meeting of the Program cannot be processed -even if you have not attended the Program.

West Zone Board Use

Received From:                                                                                    Date:                                                            

Class:              $                                                                                                                     

Membership:  $                                                                                                                       Cash    [        ]

Total:              $                          Received by:                                                                       Cheque [        ]                       
All returned cheques are subject to a $25.00 Service Charge                                 RECEIPT