2010 Skate Lesson Program & enrollment form
			To sign up: just print out the form & bring it to the 1st day of class OR scan & email it to: Lisa @EmpireRollerRink.com
	Roller Skating Enrollment Form - Empire Roller Rink 2010 Todays date:    ___________________________________________________ Date of Class:  __________________________________________________ (Circle one)      Level 1  (beginner)                   Level 2                                Level 3 Name:_________________________________________________________ Age: ____________________________DOB:_________________________ Parents Names:__________________________________________________ Home Address: __________________________________________________                          __________________________________________________ Email: __________________________________________________________ Home Phone: __________________________Cell:______________________ Shoe Size: ____________________School Enrolled:_____________________ Paid:_____________________________________________________________ Payment can be made at the beginning class date. Any questions call Lisa Trent at (573) 443-7375 or email at Lisa@empirerollerrink.com.  Thanks!