UAF Facilities Services

* = Required Fields

Contact Information:

Student First Name:

Student Last Name:

Date of Birth:

(mm/dd/yyyy)

Address:

City, State Zip:

Home Phone:

(nnn-nnn-nnnn)

Cell Phone:

(nnn-nnn-nnnn)

Emergency Phone:

(nnn-nnn-nnnn)

Email Address:

Class Information:

Class Days:

Class Time:

Start Date:

(mm/dd/yyyy)

Payment Options:

$80 for ISI Member	ISI #
$80 + $15 to Join ISI (one year)
$95 for Non-ISI Members

Terms and Conditions of Enrollment:

All applicants must pay tuition in advance.
Lessons will be given at the place and time indicated on the application. The school reserves the right to change the day and time.
No make-up classes. If the student misses a class for any reason, one recreational skate pass will be issued.
No refunds. The student may pay a onetime drop in fee of $15, which will be applied to tuition if student decides to enroll in the class.
Semester includes: 10 sessions (9 lessons, 1 testing session), 4 recreational skate passes with skate rental, skate rental for lessons, and 1 skills badge.
The above named student and their parents or guardian agree that the University of Alaska Patty Ice Arena is not responsible for loss or damage to any personal property or any injury or illness sustained during the activity or caused by any pre-existing condition.
I, the undersigned parent or legal guardian of the above named participant, hereby authorize the instructors, coaches or employees of the University of Alaska Patty Ice Arena to consent to medical, dental or surgical examination and or treatment of the above named participant and/in case of emergency authorize treatment or care at any hospital.

I skate in this class at my own risk and hereby release ISI and the host facility and their officers, directors, instructors, and personnel from all liability. I declare that the information above is true.

I do hereby grant and give ISI and the arena the right to use my or my child's photograph or image with or without my child's name, both single and in conjunction with other persons or objects for any and all purposes.

Signature:

(Signature of Parent/Guardian if Student is under 18 years old.)

For assistance or questions with this form, call 907-474-6888.

This form will be submitted via e-mail to Adam Powell and may also be submitted in hard-copy to:

UAF Facilities Services
ATTN: Patty Ice Arena, Adam Powell
BOX 757380
Fairbanks, AK 99775

Main Number: (907) 474-7000 | Website Contact: 474-7346
Physical Address: 803 Alumni Drive, Fairbanks, AK Mailing Address: P.O. Box 757380, Fairbanks, AK 99775 - 7380