VALLEY FIGURE SKATING CLUB

SKATER INFORMATION SHEET

Please complete the information below for each skating member of the family

SKATER #1

Name: ___________________________ Birthday: __________________

Address: ___________________________ USFSA #: __________________

___________________________ MIF Level**: __________________ Phone: ___________________________ Freestyle Level**: __________________

Alt Phone: ___________________________ Dance Level**: __________________
Email: ___________________________

Parent name(s): ___________________________ Primary Coach: __________________

Associate Clubs?__________________________ Secondary Coach?:__________________

Associate Member, please list __________________

Home Club: ___________________________ **as of 5/01/08

SKATER #2

Name: ___________________________ Birthday: __________________

Address: ___________________________ USFSA #: __________________

___________________________ MIF Level**: __________________ Phone: ___________________________ Freestyle Level**: __________________

Alt Phone: ___________________________ Dance Level**: __________________

Email: ___________________________

Parent name(s): ___________________________ Primary Coach: __________________

Associate Clubs?__________________________ Secondary Coach?:__________________

Associate Member, please list __________________

Home Club: ___________________________ **as of 5/01/08

SKATER #3

Name: ___________________________ Birthday: __________________

Address: ___________________________ USFSA #: __________________

___________________________ MIF Level**: __________________ Phone: ___________________________ Freestyle Level**: __________________

Alt Phone: ___________________________ Dance Level**: __________________

Email: ___________________________

Parent name(s): ___________________________ Primary Coach: __________________

Associate Clubs?__________________________ Secondary Coach?:__________________

Associate Member, please list __________________

Home Club: ___________________________ **as of 5/01/08

VFSC has a Membership Directory. This directory will be given to members only, and will be used for skating purposes ONLY.

If you do not want your address and phone number listed (only the primary number will be listed), please X here ___________. Checking this line, only your name will be listed in the directory.

05/30/08