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* 1. Name:

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* 2. Date of Birth (dd/mm/yy):

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* 3. Parent/Guardian Name:

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* 4. Street Address, Email & Phone Number

Picture for reference only.  Session days and times are subject to changes depending on interest/numbers.

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* 5. Select your choice below:

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* 6. Optional: If you selected Private Lessons, please indicate your preferred day and time below.

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* 7. I agree to have photos and/ or name of above skater published in our newsletter/ program/ Facebook.

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