Membership Form - Marquette Figure Skating Club

Note: You must be a current MFSC member in good standing to purchase ice.

PERSONAL INFORMATION

Skater Name*

First Last

Date of Birth*

Date of Birth

USFS #

Required unless new membership

Sex

U. S. Citizen*

Yes
No

Address*

Street Address City State ZIP Code

Cell or Home Phone*

Please enter the # you can be reached at the most.

Additional Phone #

Email*

Home Figure Skating Club's Name

Required unless new member

Parent/Guardian Name*

WAIVER and RELEASE of LIABILITY*

In consideration of participating in Marquette Figure Skating Club activities, I represent that I understand the nature of figure skating activities and that I am qualified, in good health and in proper physical condition to participate in such "activity"". I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the "activity". I fully understand that this "activity" involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in the "activity", the conditions in which the "activity" takes place, or the negligence of the "releasees" named below, and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs and damages I incur as a result of my participation in the "activity". I hereby release, discharge, and covenant not to sue the Marquette Figure Skating Club, United States Figure Skating, it's directors, officers, administrators, sponsors, volunteers, agents, employees, staff, instructors, trainers, other participants and if applicable, owners and lessors of premises on which the activity takes place (each considered one of the "releasees" herein) from all liability, claims, demands, losses, or damages on mu account caused or alleged to be caused in whole or in part by the negligence of the "releasees" or otherwise, including negligent rescue operations; and I further agree that if, despite this release, waiver of liability, and assumption of risk, I, or anyone on my behalf, makes a claim against any of the releasees, I will indemnify, save, and hold harmless each of the releasees from any loss, liability, damage, or cost which any may incur as the result of such claim. I have read this RELEASE and WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by checking this waiver box and have checked it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to in invalid, the balance, notwithstanding, shall continue in full force and effect.

Waiver and Release of Liability

PARENTAL CONSENT and INDEMNIFICATION AGREEMENT*

I, the minor's parent and/or legal guardian, understand the nature of the above referenced activities and the minor's experience and capabilities and believe the minor to be qualified to participate in such "activity". I hereby release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability, claims, demands, losses, or damages on the 's account caused or alleged to have been caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor's behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARAMLESS each of the releasees from any litigation expenses, attorney fees, loss liability, damage, or cost any Releasees may incur as the result of any such claim. I understand that Refunds will not be given for any reason. MEMBERSHIP AND FUNDRAISING FEES ARE NON-REFUNDABLE.

Parental Consent and Indemnification Agreement

CONSENT for MEDICAL ATTENTION or TREATMENT*

I certify that I, the member, or I, the parent/guardian of said participant, give my consent to the Marquette Figure Skating Club and the facility the activities are taking place in and their staff and to members of the MFSC, their Board of Directors, coaching staff and volunteers to obtain medical care from any licensed physician, hospital or clinic, including transportation and emergency medical services, for myself/ourselves and/or said participant for any injury that could arise from participation in these activities for the skaters listed in this registration form.

Consent for Medical Attention or Treatment

Photography Release for Minor Children*

I hereby authorize Marquette Figure Skating Club, hereafter referred to as "company", to publish photographs taken of myself and/or the minor child, and our likenesses for use in Marquette Figure Skating Club's print, online, and video-based marketing materials, as well as other company publications. I hereby release and hold harmless Marquette Figure Skating Club from any reasonable expectation of privacy or confidentiality for myself and/or for the minor child listed above associated with the images specified above. Further, I attest that I am the parent or legal guardian of the child listed above and that I have full authority to consent and authorize Marquette Figure Skating Club to use their likenesses and name. I further acknowledge that participation is voluntary and neither I, the minor child will receive financial compensation of any type associated with the taking or publication of these photographs or participation in company marketing materials or other company publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever. I hereby release Marquette Figure Skating Club, its contractors, its employees and any third parties involved in the creation or publication of company publications, from any liability for any claims by me or any third party in connection with my participation of the minor child listed above.

YES
NO

VOLUNTEER SIGN-UP*

The Marquette Figure Skating Club is a non-profit organization run by volunteers and requires help from it members. Without volunteers we cannot offer such events as Melody on Ice, Ron-Carlson Marquette International Open Competition and testing sessions. As a member you are required to help at two events. Please check two areas that you will help. Coordinator of each event will contact you with detailed job descriptions.

Select All
Fundraising
RC-MIO (competition)
Melody on Ice (Ice Show)
Test Session

MANDATORY MEMBERSHIP / FUNDRAISING REGISTRATION

Membership Options*

First Family Membership $120
Additional Family Member $69
1st Year Family Membership $65
1st Year Additional Family Membership $54
2nd Club Membership $65
Collegiate Membership (4 year Pkg) $200
Parent Membership (when child is 1st full member) $35
Board of Directors/Committee Chair $00
Unselect

MANDATORY ANNUAL FUND RAISER FEE (consumer cash cards)

Fundraiser is one per/family, 2nd family members do not have to purchase. You will receive 12 cards, sell for $10 each.

Fundraiser Fee - 12 Consumer Cash Cards $100
Unselect

PAYMENT CHOICE

Submit Check made payable to MFSC and mail to: MFSC/Johnson 48 Longyear Dr Negaunee, MI 49866

Pay Online (+2.9% convenience fee)
Submitting Check (Must be received within 5 business days)

Convenience Fee

Price: $0.00

TOTAL DUE

$0.00

Credit Card*

Card Details

Cardholder Name

ONCE YOU SUBMIT THE FORM, PLEASE GIVE IT TIME TO FULLY SEND. IF YOU CLICK IT AGAIN BEFORE IT'S DONE AND YOU ARE PAYING ONLINE, YOUR CARD MAY BE CHARGED MULTIPLE TIMES.

Email

This field is for validation purposes and should be left unchanged.