Name: __________________________________________________________________________

Address: ________________________________________________________________________

(street)

_______________________________________________________________________________

(town/city) (province) (postal code)

Phone number: _______________________ Parent’s Email address ________________________

Home Skating Club: _______________________________________________________________

Indicate the Skate Canada Section to which you belong

Skate Canada registration number: _____________________________

The STARSkate program offers opportunities for skaters of all ages to develop fundamental figure skating

skills in the areas of ice dance, skating skills, free skate and interpretive skating. HomeSense encourages

the opportunity for personal growth and the development of important life skills such as goal-setting,

self-discipline, confidence, time management, healthy lifestyle and coping strategies to deal with success and

failure that form part of the STARSkate program.

In 50 words or less please let us know how the STARSkate program has helped you attain some of these

objectives.

_______________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Skater’s signature ___________________ Parent/guardian signature __________________________

Please mail all entry forms for the draw to:

c/o Skate Canada Attention: Ryan Mussen

865 Shefford Road

Ottawa, Ontario

K1J 1H9

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