ASAI (Amateur Skating Association of Illinois)
2017-2018 GESS Club Registration
Please use this form to register for the upcoming season. Note that you must either be a registered member of another club (and USS member) or have graduated from LTS. Please contact firstname.lastname@example.org
At the end of the form you will be given the ability to pay via credit card or to bring cash/check to your first session. If you wish to pay in 3 installments this is also possible. If you want to utilize the payment plan, please choose pay by check and bring credit card information the first night; first payment will be due 9/11 followed by payments on 10/1 and 11/1 - available only for Full and Half Season options; $5 convenience charge is added to the fee)
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Choice of Sessions
(payment plan available, please choose pay by check and bring credit card information the first night; first payment will be due 9/10 followed by payments on 10/1 and 11/5 - available only for Full and Half Season options; $5 convenience charge is added to the fee)
Full Season (24 Sessions)
Half Season (16 Sesssions)
Punch Card (10 Sessions)
I will need to rent skates
Full Season - $80
Session I - $20
Session II - $20
Session III - $20
Session IV - $20
Location: Triphan Center, Hoffman Estates, IL Dates: September 2017 – August 2018
Events: Introductory, Learn to Speedskate (LTS) & GESS Program hosted
An EMT will not be present, in case of an emergency; the Hoffman Estates Fire Department will be called.
NOTE: THIS FORM MUST BE READ AND SIGNED BEFORE THE PARTICIPANT IS PERMITTED TO TAKE PART IN THE EVENT LISTED ABOVE. BY SIGNING THIS AGREEMENT, THE PARTICIPANT AFFIRMS HAVING READ IT.
IN CONSIDERATION of my involvement in the sport and activities under the auspices of U.S. Speedskating, ASAI, and Glen Ellyn Speed Skating, Inc. acknowledge, appreciate and agree that:
1. I RISK BODILY INJURY, INCLUDING PARALYSIS, DISMEMBERMENT, DISABILITY AND DEATH, AND while particular rules of my sport, equipment, and personal training and discipline may reduce this risk, THIS RISK OF INJURY DOES EXIST, AS WELL AS THE RISK OF DAMAGE TO OR LOSS OF PROPERTY;
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS; both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERS;
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual or unnecessary hazard during my presence or participation, I will bring such to the attention of the nearest by GESS, Inc. coach/member.
4. I, FOR MYSELF, AND ON BEHALF OF MY HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES, and NEXT OF KIN, HEREBY RELEASE, HOLD HARMLESS, and PROMISE NOT TO SUE U.S.
SPEEDSKATING, THE INTERNATIONAL OLYMPIC COMMITTEE, THE UNITED STATES OLYMPIC COMMITTEE, THE INTERNATIONAL SKATING UNION, THE ASAI, GLEN ELLYN SPEED SKATING, Inc., Triphan Center, Park District of Hoffman Estates, OR OTHER SPONSORING ORGANIZATIONS, THEIR OFFICERS, VOLUNTEERS, STAFF, SPONSORS AND/OR AGENTS, (“RELEASEES”) WITH RESPECT TO ANY AND ALL INJURY AND LOSS ARISING FROM MY PARTICIPATION, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, EXCEPT THAT WHICH IS THE RESULT OF GROSS NEGLIGENCE OR WANTON MISCONDUCT.
I have read this Release of Liability and Waiver Agreement, fully understand its terms and sign it freely and voluntarily.
If participant is a minor signature should be that of the participant's legal guardian.
Cash or Check at first session
Do Not Fill This Out