| | Club Certification | |
| | IMPORTANT!! The Club Certification and Parent Authorization MUSTbe signed or your entry form will be returned!! | | |
| | Club Certification: I hereby approve the entry of the above named entrant and certify that to the best of my knowledge: | | |
| | - He/She is a member in good standing of the home club listed.
- He/She is eligible to enter the specified events.
- He/She is an eligble person as defined by the rules of the USFSA.
- He/She (if under 18 years of age) is complying with standard education policy.
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| | _________________________________________________ Signature and title of club official | | __________ Date |
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| | Assumption of Risk and Waiver of Liabilty: I have read and agree to abide by the rules of this competition. I am aware that ice skating is a dangerous sport, and at the competitor's sole risk, and agree to hold harmless the USFSA, Santa Rosa Figure Skating Club, Rdwood Empire Ice Arena, directors, officers, agents and employees from any and all loss damage, and/or injury, whatsoever of any kind or nature, that may be susstained by the entrant in any manner while participating in any event of this competition. The Referee of the Competition shall have the right to determine the fitness of any entrant to skate in the competition in accordance with the current USFSA rulebook. |
| | _________________________________________________ Signature of parent or legal guardian if competitor is under the age of 18 | | __________ Date |
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| | _________________________________________________ Signature of competitor if over the age of 18 | | __________ Date |
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