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

 

Website: www.westzoneboard.ca
E-mail: wzb@sasktel.net
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

HELMET WITH FULL FACE GUARD IS MANDITORY FOR ALL CHILDREN TO PARTICIPATE 
Would you be willing to help with the first 1 or 2 lessons, until your child can get up on their own? 
           
Yes                  No

Drop off completed form with payment at the West Zone Board office. (Mail slot beside door.)
DO NOT MAIL
______________________________________________________________________________________

Payment is required at time of registration. Cheque or cash only. Please make cheques payable to
West Zone Board
.
All returned cheques are subject to a $25.00 Service Charge.
COST: $85 plus $10 for Community Membership or include your membership number above.

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.
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 [        ]                       
RECEIPT