2019 Show Registration Form

SHOW REGISTRATION

Event Date: June 22, 2019
SKATER INFORMATION:
Skater's Name *

First Name Last Name
Is skater under the age of 18? *

Yes No
Parent/Guardian Name *

First Name Last Name
Skater's Gender *
Birth Date *

Month Day Year
Age *
Height *
SKATING BACKGROUND:
Primary Rink *

Chiller Dublin Chiller Easton Chiller North NTPRD Chiller
Skater is currently taking.... *

Group lessons ONLY Private lessons ONLY Both group and private lessons n/a
Current group lesson instructor
Current class name/level
Private lesson coach *
Skating Category *

Basic Skills Free Skate Freestyle Moves in the Field
Highest Basic Skills Level Passed *
Highest Free Skate Level Passed *
Highest Freestyle Level Passed *
Favorite Jump
Jump Rotation Direction *

Counterclockwise Clockwise
Favorite Spin
Favorite Artistic Element
Highest Moves in the Field Level Passed *
CONTACT INFORMATION:
E-mail (required for all event communications) *
Preferred Phone Number *

Address *

Registration Fee *

Registration $ 150.00

Total $ 0.00

SHOW REGISTRATION