Summer Skates Registration RegistrationAthlete's Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Number*Cell NumberEmail* Gender*MaleFemaleDate of Birth* MM slash DD slash YYYY Ethnicity (for funding purposes only)*African-American/BlackAsianCaucasian/WhiteHispanicNative AmericanOtherSchool / Group HomeIs the athlete over the age of 18?* Yes No Parent / Guardian / Caregiver #1Parent #1 will receive a confirmation e-mail for this registration.Parent / Guardian / Caregiver #1* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code EmployerEmployer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number*Primary Email Address* Parent / Guardian / Caregiver #2Parent / Guardian / Caregiver #2 First Last Home Address (optional, if different) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code EmployerEmployer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone NumberParent / Guardian / Caregiver 2 Email Address Emergency ContactName* First Last Phone Number*Athlete Diagnostic InfoPlease supply any and all information that applies to your athlete.How does your athlete communicate? Speech Sign Language Non-Verbal Other If other, please explain:Does your athlete wear AFO's?NoYesDoes your athlete have seizures?NoYesIf yes, how often do they occur?How long do they last?When did their most recent seizure occur?Does your athlete have a shunt?NoYesDoes your athlete have any of the following conditions? Autism/Spectrum Disorder Cerebral Palsy Hearing Impairment Learning Disability Down Syndrome Intellectual Disability Visual Impairment Other disabilities not listed above If yes, which of the following do they use: Hearing Aid Sign Language Read Lips Additional hearing impairment info:Additional learning disability info:Intellectual DisabilityDoes your athlete have any functional vision?Other disabilities not listed above:Does your athlete have any medical limitations or precautions?NoYesIf yes:Other InfoIs your athlete eligible for reduced-fee lunches?NoYesPermissionI hereby give my permission for my athlete to participate with SABAH in weekly therapeutic and recreational sessions as well as in SABAH’s Annual Celebration on Ice Show. The athlete may be photographed, videotaped or interviewed for the purpose of improving the quality of services provided by SABAH or for publicity purposes. It is the purpose of this agreement to exempt, waive and relieve releases from liability for personal injury, property damage, and wrongful death, including if caused by negligence, including the negligence, if any, of releases. “Releases” include SABAH Inc., event hosts, other participants, sponsors, advertisers, Board of Directors, volunteers and each, their officers, directors, agents and employees.PERMISSION ACKNOWLEDGEMENT* I ACCEPT THESE TERMS OF THE PERMISSION STATEMENT Summer Skate Registration Fee Price: Would you like to receive news & updates from SABAH? Yes, I would like to be added to your mailing list. Total $0.00 Payment Options*Pay Now with Credit CardPay by CheckCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name Please call the office at 716-362-9600 if you have any questions regarding payment.CAPTCHA Join Our Mailing ListSign-up to receive information from SABAH about our events, skating schedules and much more. Success! First Name Last Name Email Join Now!
