Class Registration Signup Form

Student Registration Form

Fill out the form carefully for registration
Student Name

First Name Last Name
Birth Date

Day Month Year
Gender
Address

Street Address

Street Address Line 2

City (Suburb) State

Post Code Country
Student Email *
How did you hear about us?
Mobile Number

Area Code Phone Number
European Shoe Size (eg EURO 39)
I need the following equipment supplied please *

Wrist pads Knee pads Elbow pads Helmet I am bringing all my own protective equipment including wrist, knee, elbow pads plus helmet.
Type of lesson

Rollerblading (inline) Rollerskating (quads)
I AGREE that rollerblading / in-line skating / rollerskating, is an adventure sport with inherent risks including but not limited to fractures, sprains and strains, AND further that RollerbladingBrisbane.com.au / RollerskatingBrisbane.com.au or appointed Instructor shall not be held responsible or liable in any way for any injury caused to myself or to others by my involvement in these lessons and / or hire. I agree to wear full protective equipment during lessons / hire. No helmet - no lesson. I agree to advise my instructor if I have any medical issues (eg diabetes, asthma, knee issues, low bone density) that may impact my participation. I also agree that in the event that medical aid is required to give permission to ANY assistance deemed necessary. Photos & videos are sometimes used to assist tuition, feedback and social media purposes and I will advise instructor if I don't wish for this to be used. I agree to give at least 24 hours notice of cancellation via sms. I will send you a photo of my skates showing the brake. TYPE "I AGREE" to indicate you agree. *
WRITE YOUR NAME HERE
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Student Registration Form