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Duveneck PTA Ice Skating Party Registration
Parent/Guardian #1 First Name
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Parent/Guardian #1 Last Name
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Parent/Guardian #2 First Name
Parent/Guardian #2 Last Name
Address
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Address 2
City
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State
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Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
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North Carolina
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Ohio
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Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
Zip Code
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Phone
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Email Address
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Ice Skating Tickets
Skating tickets are $25/skater. Tickets include ice skate rental.
Skaters need to bring socks to wear. We recommend wearing a helmet (a bicycle helmet will do!) and gloves or mittens.
# Skating Tickets for TK-2nd Grade Skating Event: Friday, March 15:
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Skater Last Name, First Name:
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Age (if minor):
Skater Last Name, First Name:
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Age (if minor):
Skater Last Name, First Name:
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Age (if minor):
Skater Last Name, First Name:
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Age (if minor):
Skater Last Name, First Name:
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Age (if minor):
Skater Last Name, First Name:
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Age (if minor):
If you have more than 6 skaters per event, please place more than one order. Sorry!
# Skating Tickets for 3rd-5th Grade Skating Event: Saturday, March 16:
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Skater Last Name, First Name:
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Age (if minor):
Skater Last Name, First Name:
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Age (if minor):
Skater Last Name, First Name:
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Age (if minor):
Skater Last Name, First Name:
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Age (if minor):
Skater Last Name, First Name:
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Age (if minor):
Skater Last Name, First Name:
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Age (if minor):
If you have more than 6 skaters per event, please place more than one order. Sorry!
Food Tickets
Each food ticket costs $8, and includes two pizza slices, chips, fruit, cookie, hot chocolate and a bottled water for one person.
Food Tickets for Friday, March 15 (TK-2nd Grade):
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Food Tickets for Saturday, March 16 (3rd-5th Grade):
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Legal Agreement
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The undersigned parent(s) or guardian(s) assume all risks in connection with the participation of all individuals listed above in any and all of the PTA sponsored activities.
I attest and verify that all individuals listed above are physically fit and able to participate in any PTA sponsored activities. Further I acknowledge that is it my responsibility to understand any inherent risks associated with PTA sponsored activities and communicate those risks to all individuals named above.
I do hereby certify that to the best of my knowledge and belief all individuals named above are in good health. In the event that I, or other parent/guardian, cannot be reached in an emergency, I hereby give permission to secure proper treatment for my child(ren). I/we do hereby consent to whatever x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon or dentist and performed by or under the supervision of the medical staff of the hospital or facility furnishing medical or dental services. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs.
I/we, as parent(s) or guardian(s) of the minor(s), do hereby, for my child/children, myself, my heirs, executors and administrators, release and forever discharge and hold harmless the California State PTA, the local PTA and all officers, directors, employees, agents and volunteers of the organizations, acting officially or otherwise, from any and all claims, demands, actions or causes of action which in any way arise from the participation of any individuals listed above in any PTA sponsored activities.
By signing below, I confirm that I have carefully read and fully understand its contents. I am aware that this is a release of liability and signed it of my own free will.
Please sign
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