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Parent First Name *

Last Name *

Email *

Phone Number *

Alternative emergency contact number *

Participant Full Name *

Age *

Skate Experience

Do you need to borrow any of the following items

We (parent or guardian & participant) understand skateboarding can result in injury even while wearing protective gear & while Wellness Riders coaches do their best to mitigate the risk of accidents occuring, they are not liable for participant injury! *

YES

We may capture group photos/videos for social media. Before sharing any individual photos, we will ask for your permission. Do you and the participant consent to being in photos/videos? If not, please remind us on the day. *

YES

NO

Signature

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Initials *

I Consent to Receive SMS and Email Communication from Wellness Riders

Privacy Policy

Email: [email protected]

Phone: 022 413 9484

Book a Free Session

Fill in this form if you want to join us for a single free session anytime

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