SKATEBOARD LESSONS REGISTRATION FORM

Step 1:
Please provide the following information:
Asterisk (*) fields are required. Please provide as much information as possible so we can better take care of you!

Personal Information
*Primary Contact
First & Last Name		  
*Home Phone:
*Cell Phone:
*Email Address:
Street Address
City
State
Zip Code
*Student_Name'(s):
*Student Age'(s):
(Ages 4 & up welcome)
*Are you the legal guardian Yes No (The legal guardian must fill out this form)
*Emergency Contact (Name)
*Emergency Contact (Phone)
Please let us know of any medical conditions you may have that would require
any special assistance. If none please leave blank:

Lesson Information

*Select a Level: Description  
*Select a Lesson Package: Please note: Lessons are 1 hour long. If you purchase a package of 2 or more lessons and would like to have a 2 or 3 hour long lesson on the same day please let us know in the comments area below.

*N.A.S.S.A Membership
(Inculdes Insurance)

 Download Membership Form
*Dates requested
 Please note: The Cove skate park opens at 12 Noon.
Alt/2nd date requested For the current schedule. Click Here
Alt/3rd date requested  
*Do you have a skateboard? Yes No
*Do you have a safety gear? Yes No  
  
*Will you purchase these items before the lesson?
Yes No  

Any Additional Info/Comments?

Invite Your Friends!

If you would like to invite some friends to join your lesson,
enter their email addresses here:

Add a message for your friends here:
 
Please read the WAIVER carefully and check the boxes below.
* I have read the WAIVER. Yes No  

* I ASSUME FULL RESPONSIBILITY Yes No

 
 
       

 

 

 

 

 
 
 
 
 

 

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