Lesson Request Form

Name of Contact Person(Required)

First Last

Phone(Required)

Email(Required)

Preferred Method of Contact(Required)

Phone Call

Text Message

Email

Which days/times typically work best for you?(Required)

Weekdays

Weeknights

Weekends

Flexible

Number of Skaters for This Lesson(Required)

Please enter a number from 1 to 8.

Please enter a number between 1 and 8

Age(s) of skater(s) for this lesson.(Required)

Has the Skater roller skated before?(Required)

Never

A few times

Regularly

Competitively

How would you describe your skating level?(Required)

Beginner

Intermediate

Advanced

What are your main goal(s) for taking roller skating lessons?(Required)

Learn to Skate

Improve balance and control

Figure/Competitive Skating

Fitness

New Hobby

Do you have a particular event, performance or timeline goal in mind?(Required)

How often would you like to take lessons?(Required)

Weekly

Biweekly

Monthly

Not sure yet

Preferred lesson length(Required)

30 minutes

60 minutes

Other

Thank You, if you have any additional information for the coach put it here

Once this form is submitted a coach will contact you within 48 hours.