1st Annual Ìllinois High School Team

Figure Skating Competition
Monday, March 12, 2012

IndividuaI Skater Entry Form
FiII out and return to your Team Representative as soon as possibIe.

Skaters Name _______________________________________________________

School/District ___________________________________Grade _______________

Team Name ________________________________________________________

USFSA or ÌSÌ number _________________________________ (USFSA or ÌSÌ)
Highest Free Skating Test Passed _______________________
Highest Moves in the Field Test Passed ___________________
Highest Dance Test Passed _____________________________

Competitor, Parent and Guardian Statement:
Ì understand that this entry must be received by February 29, 2012. The competition
committee reserves the right to combine groups.

The undersigned agrees to hold harmless U.S. Figure Skating, Ìllinois Skating Council,
Skokie Valley Figure Skating Club, Glacier Ìce Arena, and the school district and the school(s)
named above and their employees and agents from any and all loss, damage, and/or injury
that may be sustained by the entrant in any manner while participating in any of the activities
of said competition.

Parent or Guardian Signature ____________________________________________

Skater's Signature if over 18 _____________________________________________

Please indicate your skating level:
Team LeveI A_____________ B_____________ C______________

E-Mail (only if you want to receive e-mail about this competition)


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