2019-2020 Winter Participant Intake
First Name *
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Last Name *
Your answer
Date of Birth *
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DD
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YYYY
Street Address *
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City *
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State *
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Zip Code *
Your answer
Do you live within Durango city limits? *
If from out of town, where are you staying in Durango?
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Desired Date of Lesson *
This does not reserve a lesson. You must contact our office to schedule a lesson.
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Cell Phone *
Please include area code.
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Home Phone
Please include area code.
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Work Phone
Please include area code.
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Email *
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Gender
Age *
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Height *
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Weight *
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Shoe Size *
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Emergency Contact Name *
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Emergency Contact Relationship *
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Emergency Contact Number *
Please include area code.
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Are you your own legal guardian? *
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