Learn To Skate Registration

SPRING 2012

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)

$126 / 9 wk session / 90 min per day

Please check class level below: (Snowplow Sam = beginners, 5yr and under)
Ask us about Private Lessons and Junior Club!

The first 1/2 hr for Snowplow Sam 1 and Basic 1 are full. If you wish to register for this level you may do so only in the third 1/2 hr time frame.

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