Club de patinage de vitesse Concordes

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First Name

Last Name

Username

Password

Gender

Date of Birth

Captcha

Address

Address 2

City

Postal Code (A#A #A#)

Country

State / Province

Home Phone

Work Phone

Work Extension

Cell Phone

Add my name to the Member's List

Yes

NOTE: To be covered under the insurance policy, parents and guardians must sign-up as Associate members of the club. For minor skaters under the age of 18, it is mandatory for at least one parent per family must also sign-up separately as an Associate.

Parent / Guardian Name (Associate #1)

Parent / Guardian Name (Associate #2)

Emergency Contact Name

Emergency Contact Relation

Emergency Contact Phone(1):

Emergency Contact Phone(2)

Do you have any allergies?

Yes

Do you take any prescription medications?

Yes

Provide any details of relevant medical information

Home Club

OSSA Helmet Cover

SSC Number

Ranking (Personal Best)

For skaters that compete in SCC sanctionned meets, their Personal Best (PB) is used for ranking at the start of the meet.
Please keep track of your current PB for at least one of Distances.
Although OSSA documents some PBs on their ranking list, it may not be current.

See your Coach if you do not have your PB.

500m (111m track)

400m (100m track)