Class Registration Signup Form

Student Registration Form

Fill out the form carefully for registration
Student Name

First NameLast Name
Birth Date

DayMonthYear
Gender
Address

Street Address

Street Address Line 2

City (Suburb)State

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

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

Wrist padsKnee padsElbow padsHelmetI 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