Buffalo Speed Skating Club 44 Park Street, Holland, NY

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1 Club Skating & Membership Fees Club Membership Dues - $50.00, (tax deductible). All skaters (other than drop in s) must be members of the BSC. The $50.00 per person membership dues are separate from the skating fees and must be paid in full at time of registration. Skaters have the option of paying their skating fees in full or with two separate payments. If choosing the two payment option, the first payment is due on September 11, 2016, (September 14 if you are only skating on Wednesdays), and the second payment on January 4, 2017, (January, 8 if you are only skating on Wednesdays). The two payment option is only available if payment is received prior to or on the start dates of the season, and only if skating the entire season. The amounts of the two payment options are contained in the parentheses below the full payment amount for each skating category. Please note that your payment and all forms must be received before you can skate. If joining after the season begins, the cost will be calculated based on the number of skating sessions left, and payment must be received in full. Skaters must also be members of US SPEEDSKATING - Sunday: Cazenovia - September 11, through March, 4:00PM - 5:50PM. Wednesday: Riverside - September 14, through March, 7:00PM - 7:50PM Buffalo Speed Skating Club 44 Park Street, Holland, NY Skating Fees (USD) Two Day $ ($320/$210) One Day Wednesday $ ($125/$80) One Day Sunday $ ($220/$145) All skating fees receive a $20.00 discount if paid in full by September 11, (September 14 if you are only skating on Wednesdays) Family Plan (two or more skaters) Two days, only $850 ($510/$340) Family Plan (two or more skaters) One day Wednesday, only $330 ($200/$130) Family Plan (two or more skaters) One day Sunday, only $585 ($350/$235) Additional day for one day skaters - Wednesday - $10 / Sunday - $20 Skate Rental: $10 per full or partial month. Must be paid in advance for the season, or part there of. $70 - entire season. Learn to Skate Program - 3 sessions only $40.00 including skates. If you join the club and skate after the program, the $40.00 fee will be credited towards your skating fees. Drop in skate (unaffiliated skaters) - Wednesday - $10 / Sunday - $20 Drop in skate (members of other clubs) - Two skates per season at no cost, thereafter Wednesday - $10 and Sunday - $20 Refund Policy: Skating and Membership fees are non-refundable. Skate rental fees are refundable for full months only. Please send your check (payable to Buffalo Speed Skating Club), your signed waiver, skating registration form, membership application, code of conduct form and a copy of your US Speedskating membership card to: Christina Pielechowski - 44 Park Street, Holland, NY 14080

2 Buffalo Speed Skating Club 44 Park Street, Holland, NY Skating Registration Name: Address: City: State: Zip: Phone: Home Work Cell US Speedskating Membership The club has my/our card(s) on file Enclosed is my/our card(s) Date of Birth: (month/day/year) Sex: Male Female USS Membership Number Skater Category: Two days One Day Sunday One Day Wednesday Family Plan (two or more skaters) Two days Family Plan (two or more skaters) One day Sunday Family Plan (two or more skaters) One day Wednesday Additional family members who will skating. Name(s) D.O.B. Sex: Male / Female USS Membership Number In case of emergency please contact: Name: Phone: Relationship: I/we will be renting club skates. Name(s): Foot measurement(s): Street shoe size(s): Refund Policy: Membership & Skating fees are non-refundable. Skate rental fees are refundable for full months only. Amount Enclosed (USD) $ $50 Membership(s) $ Skating Fees $ $20 discount if paid in full, (entire season only). $ Skate Rental $ Total Please send Your check (payable to Buffalo Speed Skating Club); Signed Waiver; Membership Application; Skating Registration form; Code of Conduct form and a Copy of your US Speedskating membership card if it is not on file to: Christina Pielechowski - 44 Park Street, Holland, NY 14080

3 Buffalo Speed Skating Club 44 Park Street Holland, NY Membership Application Membership Dues - $50 (USD) The Buffalo Speedskating Club is a 501(c)(3) Not For Profit Organization. As such your membership dues may be tax deductible. Membership is open to all skaters, coaches, officials, parents/guardians and supporters of the BSC. Any prospective member who is under the age of eighteen must have written permission of a parent or guardian. The privileges and responsibilities of members are spelled out in the club s bylaws and Code of Conduct which are available on our website. All members (skating and non-skating) must sign and submit a copy of the club s Code of Conduct and waiver. Name: DOB Address: City: State: Zip: Phone: Home Work Cell Membership Type, Check One: Skater Supporter (non skating) Coach Please read and sign the following: I agree to support the bylaws and code of conduct of the Buffalo Speedskating Club in consideration of my acceptance as a member. Applicant s Signature (Parent or guardian if member is under 18 years) Date Please submit your membership payment of $50 along with your signed waiver and Code of Conduct. Note: If this application is submitted along with your skating registration please include the $50 payment along with your ice fees. Refund Policy: Membership dues are non-refundable. Please send your check (payable to Buffalo Speed Skating Club) to: Christina Pielechowski - 44 Park Street, Holland, NY 14080

4 Buffalo Speed Skating Club 44 Park Street Holland, NY Wavier I acknowledge that, as in all sports and exercise, there is an element of risk and that I am physically and medically capable of participating in skating activities. In consideration of the acceptance of my application and permission to participate in any of the Buffalo Speed Skating Club events, activities, or training sessions, on or off the ice. I myself, my heirs, executors, administrators, successors, and assigns RELEASE, WAIVE and FOR- EVER DISCHARGE the Buffalo Speed Skating Club, It s organizers and coaches, US Speedskating, Cazenovia Ice Rink, Cazenovia Park Youth Hockey Association, Riverside Ice Rink, City of Buffalo, South Buffalo Community Association, Hasek s Heroes, The Northtown Center, Town of Amherst and all other associations, sanctioning bodies and sponsoring companies, and all their respective agents, officials, servants, contractors, representatives, and assigns of and from all claims, demands, damage, costs, expense, actions, and causes of action, OF ANY KIND WHATSOEVER, whether in law or equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reason of my participation in any event organized by the team, whether as a spectator, participant, competitor, or otherwise, whether prior to, during or subsequent to the event and notwithstanding the same may have been contributed to or by negligence of any of the aforesaid. I further undertake to skate safely and wear protective equipment at all times. All skaters must wear an ANSI/SNELL certified helmet, cut resistant neck guard, knee pads and full fingered gloves. I have read this waiver in its entirety, and fully understand its contents. Date: (Parent or guardian if any participant is a minor)

5 BUFFALO SPEEDSKATING CLUB CODE OF CONDUCT All members and parents of minor skaters are required to review, discuss, and accept this Code of Conduct and indicate that they have read and understand their responsibilities by signing this agreement. Buffalo Speedskating strives to create a safe and enjoyable environment in which all athletes can work towards reaching their individual goals and potential. Towards this end the club and it s members benefit from having a uniform standard code of conduct. This code applies to all BSC members, athletes, coaches, and parents, at any club practice, meet, activity or event, wherever and whenever it may be held. The following are expectations for members of the Buffalo Speedskating Club. Skaters must at all times be concerned for the safety of themselves and of their fellow skaters by: Wearing required safety equipment consisting minimally of a helmet, neck guard, knee pads, gloves, long pants and a long sleeve top. Entering and exiting the rink only when safe to do so. Following directions as to where they are suppose to be on the rink. Being aware of the skaters around them. Behaving in a manner consistent with being on the ice with other skaters, and showing concern for everyone s safety. Communicating any concerns they may have for their own well being and for that of their fellow athletes. Athletes are expected to enjoy themselves and have fun, and to encourage all others to do the same. Athletes are expected to demonstrate a positive attitude and to promote positive self-esteem in all members. All members will support the fair and equal opportunity of all athletes to participate in practices or activities, regardless of their skill level. All members will support and promote the values upon which the club s code is based: fairness, respect and achievement. Athletes are expected to display proper respect and sportsmanship toward their fellow skaters, coaches, officials, parents, and the general public. Athletes will take proper care of all equipment and the facilities in which they participate. Athletes will, whenever possible, arrive at practice with enough time to be on the ice and ready to skate at the designated time, so as to not disrupt the flow of practice. Skaters and those accompanying them, will help out during practices (when possible), by taking mats on and off the ice, filling water buckets, etc. It is expected that those that can help off ice will let the appropriate club members know that they are available. Page 1

6 Members will be up to date on their membership dues, and skaters on their skating fees. Skaters must have a current US Speedskating membership, and will have provided the club with a copy of their membership card. Parents or their designate shall be present at all sessions and activities that their child is involved it unless receiving permission from the practice or activity coach to do otherwise. Athletes and their parents or their designate acknowledge and understand that there will be consequences for inappropriate behavior, conduct or actions. Athletes and their parents or their designate will accept the club s decisions regarding safety, discipline and club rules or duties. The practice or activity coach, in consultation with others including designated club personnel, are responsible for providing immediate consequences for inappropriate behavior, conduct or actions. These may be, but are not limited to: A time out from a practice or activity. The request for direct supervision of a child by the parents or their designate during a practice or activity. Removal from a practice or activity. Severe or persistent violations may also be subject to disciplinary action by the Board as outlined in the club By-Laws. These may be, but are not limited to: A suspension of membership and all privileges for a designated period of time. The request for continued direct supervision of a child by the parents or their designate during practices or activities. Revocation of membership. Parents or their designate will be informed of disciplinary actions involving their child. ACCEPTANCE OF CODE OF CONDUCT. PLEASE READ CAREFULLY. I, the undersigned, acknowledge that by signing below, I have read and understand the terms of the Buffalo Speedskating Club Code of Conduct and agree to be bound by its terms. Printed Name of Member(s): DOB of Member(s): Signature of Member(s): Signature of Parent or guardian (if member(s) is under 18): Date: Page 2 Revision 7 - July 3, 2016