Member's First Name
Member's Last Name
Parent/Legal Guardian's Name, Required for all minors.
(optional)
2nd Parent/Legal Guardian's Name, Required for all minors.
(optional)
Member's Age
Member's Date of Birth
Street Address
City
State
Zip Code
1st Contact Phone Number (parent/guardian number for minors)
2nd Contact Phone Number (parent/guardian number for minors)
TERMS/POLICIES: Please read all items below and check that you agree & understand them as they will be enforced.
Terms/Waiver: This is a skate & play at your own risk facility. Please read the full details at www.HighRollerSkating.com
