Official Entry Application Form
2000 Crystalline Classic Competition

Name: _____________________________ (Please type or print legibly)

Club Certification
IMPORTANT !! The club certification and Parental Authorization MUST be 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:
1. Entrant is a member in good standing of the Home Club listed
2. Entrant is eligible to enter the specified events
3. Entrant is an eligible person as defined by the USFSA
4. Entrant (if under 18 years of age ) is complying with standard education policy

_______________________________________ ____________________________________
Print name and title of club Official Signature of Club Official Date

Assumption Of Risk and Waiver of Liability: 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 Redwood Empire Ice Operations Inc., The Santa Rosa Figure Skating Club and The United States Figure Skating Association, and/or directors, officers, agents and employees from any and all loss, damage, and / or injury, whatsoever kind or nature, that may be sustained by the entrant in any manner while participating in any event of this competition.
The Chief 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.

_______________________________________________ ____________
Print name and provide signature of parent or guardian for competitor under 18 Yrs. Date
_____________________________________________________________________________
Print name and provide Signature of Competitor if over the age of 18 years Date



Entry Fees: First Singles event $60 _______

For each additional event $30 _______

Pairs ( per couple ) $65 _______

Groups & Synch. Skating Teams: $60.00 + $5 per person _______

Special Needs $15 _______

Make checks payable to: Total amount enclosed $ _______
“Santa Rosa Figure Skating Club” Total # of events entered _______
( $50 charge for returned checks )
Mail to: Carol Wyckoff/SRFSC ENTRIES MUST BE POSTMARKED BY MIDNIGHT
1667 West Steele Lane FEBRUARY 18, 2026
Santa Rosa, Ca. 95403 All entries accepted after this date will be subject to
(707) 546-7147 ext 867 a $25.00 late fee.


FOR SANTA ROSA FSC Use Only:
Date received: _________ Paid by check/Money order # ________ Total amt. $ _______