2010 Burlington Hockey & Skating Assoc. Basic Skills Winter Skate
Basic Skills Skate with U.S. Competition
Saturday, January 16, 2010
US Figure Skating Association Approved by US Figure Skating
Name_________________________________________________________ Sex ____ Birthdate_____/______/_______
Last First
Address______________________________________________________ City ________________________________
State______ Zip______ _________Email Address_________________________________________________________
Area Code/Phone # (________)________-___________ US Figure Skating/ Basic Skills Number_____________________
Club or Program ___________________________________________________________________________________
(Must be on application)
Professional’s/Coach Name______________________________________ Tel # ________________________________
Last Basic Skills/ Advance Skills Level Passed __________________________________ex. Basic 3, Freeskate 5
(As of December 7, 2009)
US Figure Skating Test Level:______________________________ (As of December 7, 2009)
REMINDER: All Snowplow Sam & Basic Levels 1 through 8 MUST SKATE AT HIGHEST LEVEL PASSED. Skaters in other events may skate at HIGHEST LEVEL PASSED OR ONE LEVEL HIGHER BUT NOT AT BOTH LEVELS.
Please check the event(s) you are entering:
Basic Elements (No Music): Basic Free Skate Program (With Music):
______ Snowplow Sam ______Snowplow Sam
______ Basic 1 ______ Basic 5 ______Basic 1 _____Basic 5
______ Basic 2 ______ Basic 6 ______Basic 2 _____Basic 6
______ Basic 3 ______ Basic 7 ______Basic 3 _____Basic 7
_____ _Basic 4 ______ Basic 8 ______Basic 4 _____Basic 8
Free Skate Elements/Compulsories (NO Music): Free Skate Program (With Music):
______ Free Skate 1_____ _Free Skate 4 ______ Free Skate 1 ______ Free Skate 4
______ Free Skate 2______ Free Skate 5 ______ Free Skate 2 ______ Free Skate 5
______ Free Skate 3______ Free Skate 6 ______ Free Skate 3 ______ Free Skate 6
Showcase Program (With Music)
______Snow Plow Sam- Basic 2
______Basic 2 – Basic 8
______Free Skate 1- Free Skate 6
ENTRY FEE IS $40.00 PER EVENT, $25 PER EACH ADDITIONAL EVENT
First Event $ 40.00____
Additional Event $________ **Make Check or Money Order Payable To: BHSA**
Total: $__________
The completed entry form, with fees, must be postmarked no later than December 7, 2009
Mail to: 2010 BHSA Basic Skills Winter Skate, Attn: Kristine Perrotti, 3 Floyd St, Billerica, MA 01821
Additional information: Kristine Perrotti @ klperrotti@hotmail.com or you may call Kristine at 978-337-8371.
Entry fees are not refundable after 12-7-09
Certification of Competitor: The Competitor is eligible to enter the events checked. It is agreed that the competitor and family holds Burlington Hockey & Skating Assoc. harmless from any and all liability either during practice, or the competition, or from any and all liability for damages to or loss of property.
**INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED-- ALL SIGNATURES NECESSARY**
Parent/Guardian Signature________________________________________ Email:______________________________
Professional/Coach Signature______________________________________Email:______________________________
**Verify Levels Before Signing**
Program Director or Club Officer Signature________________________________________________________________
_________________________________________________________________________________________________
**Office Use Only: Date Rec’d_________________ Amount _________________Payment Type_____________________.