Learn To Skate Registration

SPRING 2013

First Name

Last Name

Age

Parent First/Last Name

Street Address

City

State

Zip Code

Phone Number

Cell Phone

Date of Birth

Email Address

Date

Parent Verification

Checking this box and
submission of this form
indicates that I am the
parent/guardian of any
skaters listed that are
not 18 yrs old or older.

I am the parent or legal guardian of the above named skater(s)

Select one class, the remainder of the time will be practice time

$126 / (8 classes of 30 minutes group lesson & 60 minutes practice time)

First Half-Hour

Second Half-Hour

Third Half-Hour

Credit Card Information

Our orders are processed by PayPal. Once your form has been submitted you will be forwarded to PayPal where you will then enter in your payment information.

Indicates Response Required