FIGURE SKATING CLUB OF OMAHA

FIGURE SKATING CLUB OF OMAHA 2018-2019 MEMBERSHIP APPLICATION PLEASE NOTE: ALL PAGES OF THIS FORM MUST BE COMPLETED! MISSING INFORMATION WILL RESULT IN DELAYED PROCESSING MEMBERSHIP RECORD **MEMBERS UNDER 18 YEARS OF AGE MUST HAVE A PARENT OR GUARDIAN JOIN FSCO** **COACHES MUST BE CURRENT MEMBERS OF PROFESSIONAL SKATERS ASSOCIATION (PSA)** First Family Member (Please note this member will receive all FSCO & USFS correspondence) Name Address City State Zip Home Phone Work/Cell Phone E-Mail Address Birth Date USFS Member # Gender (circle one) M F U.S. Citizen(circle one) Yes No Would you like your contact information to be published in the club directory for our members? Yes, please publish my information in the directory No, I do not want my information in the directory How would you like to receive the club s monthly newsletter? (circle one) E-mail or US mail PRIMARY ACTIVITY: (Select One) Parent/Guardian Coach Competitive Skater Recreational Skater US Figure Skating Official/Officer Club Officer/BoardMember Other SECONDARY ACTIVITIES: (Select All that apply) Parent/Guardian Coach Competitive Skater Recreational Skater US Figure Skating Official/Officer Club Officer/BoardMember Other ELIGIBILITY STATUS (Circle One): Eligible Ineligible/Restricted Additional Family Members (If there is a different e-mail or phone number than first family member, please include below.) Name (& Alt. Email/Phone #) Birth Date USFS Member # Gender US Citizen 1. M F Y N 2. M F Y N 3. M F Y N 4. M F Y N

MEMBERSHIP TYPES & DUES SUMMARY ** MEMBERS UNDER AGE 18 MUST HAVE A PARENT/GUARDIAN ALSO JOIN FSCO ** Membership Type Membership Cost Total HOME CLUB Family Membership (1 Adult + 1 Child) $120.00 $ HOME CLUB First Family Member (Age 18 or Over) $85.00 $ HOME CLUB Additional Members (Child or Adult) $35.00 each $ HOME CLUB Judge/Official/Coach/Off-Ice Instructor $60.00 $ (Coaches must have current PSA membership) * INTRODUCTORY Family Membership (1 Adult + 1 Child) $70.00 $ * INTRODUCTORY First Family Member (Age 18 or Over) $45.00 $ * INTRODUCTORY Additional Members (Child or Adult) $25.00 each $ * Introductory memberships are for first-time club members. This special pricing may used only once. ** COLLEGIATE $110.00 $ ** Collegiate memberships are specially priced four-year memberships and may used only once. NON-HOME CLUB/ASSOCIATE Individual Member (Age 18 or Over) $25.00 $ Name of Home Club: NON-HOME CLUB/ASSOCIATE Each Additional Member $10.00 $ Tax-Deductible Donation (Thank you!) $ Cash Check # Total Enclosed $ Please Make Check Payable to FSCO. Mail Check and Completed form(s) to: Krista Hazuka FSCO Membership Chair 2411 S Mineral Dr Papillion, NE 68046 FSC Omaha Photo Permission Form Throughout the year, FSC Omaha skaters and their families participate in activities, competitions, and social events in which they may be photographed or videotaped. This includes but is not limited to competition photos, ice shows, class activities, or other special FSC Omaha events. FSC Omaha would like to use these photos for publicity, illustration, or advertising purposes. Please select yes or no for each section. If a choice is NOT made, we will assume your answer is yes. I give permission for photographs of to appear in the following: Yes No Displays including but not limited to display cases at the rink and traveling displays used at activity booths Yes No Advertising including but not limited to registration forms, flyers used to promote club programs, or display posters for special events Yes No FSCO Publications including but not limited to club newsletter, show forms, Banquet slideshow, or other entertainment/informational publications for Club members and their families. First and last name may be published. Yes No Outside Publications including but not limited to articles in Skating magazine, Omaha World Herald, or other local news publications. First and last name may be published. Yes No Website including but not limited to main pages of our club website and our photo storage website. Parent or Guardian signature: Date:

THE FOLLOWING FORMS MUST BE COMPLETED AND SIGNED Figure Skating Club of Omaha Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement In consideration of participating in Figure Skating Club of Omaha ( FSCO ) activities, I represent that I understand the nature of figure skating activities ( activity ) 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 Figure Skating Club of Omaha, 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 my 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. The Figure Skating Club of Omaha has the right, but not the obligation, to provide rules, regulations and/or ice monitors for Club Ice. We hereby acknowledge that the Figure Skating Club of Omaha shall not be responsible for the supervision of the members at Club Ice. I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed 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 be invalid, the balance, notwithstanding, shall continue in full force and effect. (participants under the age of 18 must have parental signature on the following consent form.) 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 minor 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 claims against any of the above Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS 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. Printed Name of Parent/Guardian Date Parent/Guardian Signature (parent/guardian signature required if member(s)/skater(s) is under 18 years of age)

SafeSport Statement and Skater Code of Conduct for New and Renewing Members The following code of conduct applies to all participants in activities hosted, supported, sponsored or engaged in by U.S. Figure Skating and Figure Skating Club of Omaha including but not limited to competitions, exhibitions, training camps and local rink activities. I recognize that my participation or my child's in all the activities associated with U.S. Figure Skating and Figure Skating Club of Omaha is an honor and privilege that carries certain responsibilities. I agree to fully abide by the rules and guidelines set forth by U.S. Figure Skating or its properly designated agents. U.S. Figure Skating Member Code of Conduct GR 1.02 I recognize that my participation in all activities hosted, supported, sponsored or engaged in by U.S. Figure Skating, including but not limited to competitions, exhibitions and training camps, is an honor and privilege that carries certain responsibilities. I agree to fully abide by the rules and guidelines set forth by U.S. Figure Skating or its properly designated agents. As a precondition to participation in activities hosted, supported, sponsored or engaged in by U.S. Figure Skating, I will adhere to the following tenets in good faith: A. I will exhibit the highest standards of fairness, ethical behavior and genuine good sportsmanship in all of my relations with others. B. I will not damage public or private property. I understand that I may be held financially responsible for damage deemed to be wantonly or willfully executed on my part, and that I may be subject to disciplinary action by U.S. Figure Skating. C. I will not use or possess illegal drugs, and I will not engage in criminal activity. I understand that, if I am found to use or possess illegal drugs, or if I am found to engage in any criminal activity during any activity hosted, supported, sponsored or engaged in by U.S. Figure Skating, I may be subject to criminal penalties as well as penalties imposed by U.S. Figure Skating. D. I will adhere to the rules of U.S. Figure Skating and the host organization at all activities hosted, supported, sponsored or engaged in by U.S. Figure Skating. E. I will comply with all applicable anti-doping rules including, but not limited to, ISU and USADA anti-doping rules. F. I will conduct myself in a manner not detrimental to the welfare of figure skating. I understand that my actions reflect on U.S. Figure Skating and the sport of figure skating both positively and negatively. I understand that if my acts, statements, or conduct are considered detrimental to the welfare of figure skating by the appropriate authority, I may be subject to penalties imposed by U.S. Figure Skating pursuant to GR 1.04. G. I understand that the penalties that may be imposed may include, but are not limited to, loss of future international selections, loss of financial support from U.S. Figure Skating and its Memorial Fund, and loss of participation in activities hosted, supported, sponsored or engaged in by U.S. Figure Skating. H. I understand that all disciplinary proceedings will be conducted pursuant to Article XXV, Section 3, of the U.S. Figure Skating bylaws, and that my rights and remedies are derived therefrom. U.S. Figure Skating Member Code of Conduct GR 1.03 U.S. Figure Skating will not tolerate or condone any form of harassment (including sexual harassment), misconduct, (including sexual, physical and emotional misconduct), bullying or hazing of any of its members including coaches, officials, directors, employees, parents, athletes and volunteers--or any other persons--while they are participating in or preparing for a figure skating activity or event conducted under the auspices of U.S. Figure Skating. U.S. Figure Skating Safesport Requirements for Volunteers Earlier this year, U.S. Figure Skating announced it has expanded the list of adults required to complete Safesport training and background checks for the 2018-19 membership year. This will affect members and volunteers, over the age of 18, who are in a position of authority over an athlete or anyone who has frequent contact with athletes. FSCO General Safety Guidelines and Etiquette Figure Skating Club of Omaha is committed to creating a safe and positive environment for members physical, emotional and social development and ensuring that it promotes an environment free of misconduct. This Skater Code of Conduct has been established to ensure the safety of all members using our ice to ensure quality practice time for all home club, associate, nonmembers, and guests who purchase ice from the club and who participate in all club-related activities. 1. All skaters, regardless of whether they hold home club, associate, non-member, or guest status, must follow and uphold the provisions in this Skater Code of Conduct regarding behavior on and off the ice. All club members are expected to

exhibit good sportsmanship and be courteous toward their fellow skaters, coaches, parents/guardians, US Figure Skating officials, and guests. 2. FSCO is committed to promoting a positive and friendly environment for all skaters. Remember the Golden Rule treat other people like you want to be treated with respect. Ice Etiquette and Safety 1. Skaters must sign in and pay for each session before stepping on the ice. 2. Respect the rights of others, respect the arena s property, and respect the property of others. 3. While in lesson or practice, it is the skater s responsibilty to always be conscientious and aware of other skaters around them. Be understanding if someone gets in your way. Look both ways before leaving the boards or crossing the ice. Avoid standing in the middle of the ice or any of the jumping corners. 4. Skaters must skate with the flow of other skaters and familiarize themselves with the most commonly used areas for jumps and spins (for example: Lutz corners.) 5. The only time a skater has the SOLE right of way is when they are skating their program to music. When you hear another skater s music, please extend that person the courtesy and move out of their path momentarily. This only takes a moment and you will enjoy the same courtesy while you are performing your program. 6. Advanced skaters are expected to exhibit patience toward beginner members of the club. Remember, you were an inexperienced skater once, and it takes time for our future generation to advance to the point where they are completely comfortable skating with all levels of skaters. Unsafe or Discourteous Behavior Unsafe or discourteous behavior of any kind will not be tolerated. Examples of prohibited behavior include (but are not limited to): being verbally abusive to other skaters or coaches; deliberately challenging, scaring, or blocking another skater; kicking holes, scraping, or stomping the ice or boards. Violations and how they will be addressed The violation of any provision of this Code will be addressed at the time it occurs by a member of the club Board of Directors following the procedures outlined in the conflict resolution process. First offense Club member will be addressed verbally (in private) regarding the violation. Second offense The member will be removed from the activity and given a written warning. A face-to-face meeting with the member and, if a minor, the member s parent or legal guardian will be conducted. Repeated offenses Repeat offenses will be taken very seriously by the club board of directors. Discipline may include loss of club privileges for extended periods, and/or revocation of club membership. In the case of egregious offenses, Club leadership is required to make a report to US Figure Skating SafeSport, local law enforcement and/or child protective services. Safesport Statement & Codes of Conduct Agreement I,, (print member s name) have read the Safesport Statement, Codes of Conduct and General Safety Etiquette and agree to uphold all guidelines and tenets of this document. Member s signature (18 or older) Parent/guardian s signature (if member is under age 18) Date: If I volunteer for FSCO, I understand that training and background checks may be required for certain types of volunteering (age 18 and over) due to Safesport regulations and I will comply with any requirements as needed. Adult Participant/Parent/Guardian Signature Date