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Skaters Name *

Partent/Guardian's Name (If applicable)

Cell Phone *

Can we contact you about class via text? *

• Yes
• No

Email *

What city do you live in?

What is your childs age. (If applicable)

What would you like to get out of this class. Or how can we help you get to your roller skating goals and aspirations.

How did you find us?

Phone

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