Parent/Guardian First Name
Parent/Guardian Last Name
Contact Phone Number
Email AddressUsed for communication for the program.
Attending Parent/Guardian Full Name
Attending Parent/Guardian's Birth Date (Insurance Purposes)
Attending Parent/Guardian Skating History
Player's First Name
Player's Last Name
Player's Birth Date
Player's Health Care Number
For safety purpose, please list any health conditions, disabilities, allergies, etc.
Attending SchoolPlease provide us with the elementary school your player or your family attends.
Emergency Contact Name
Emergency Contact Number