step & skate summer academy

CHILD information
& RELEASE form

Parent/Registrant Name

Phone

Please complete another form if you have multiple children registered for the Summer Academy.

Registered Child

Child Date of Birth

Ticket Type (Must Have Previously Purchased)

Single Session ($40)

5-Session Bundle ($150)

Child Health Conditions/Allergies/Dietary Restrictions

Emergency Contact Name

Emergency Phone

Relationship to Child

I agree to the terms & conditions of the Liability Waiver.

I grant permission for the use of my child's image as outlined in the Liability Waiver & Media Release.

Yes

Thanks for submitting!