Registration Form — Bearings Skateboard Academy

Student Name

First Name

Last Name

Birthdate

MM

DD

YYYY

Sex

Male

Female

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone

(###)

###

####

Parent/Guardian Email

Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Skateboarding Level

Program

Please pick the program you are scheduled for or plan to attend.

Goals

Registration

Please complete if you are attending or plan to attend any of our Private Skateboard Lessons, Booger Tour™, or Adventure Friday™ Camps. Thank You!