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BMX & Skateboarding Application Form
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* Indicates required question
PARTICIPANT DETAILS
First Name:
*
Your answer
Surname:
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
What Sport are you interested in?
*
BMX
Skateboarding
What made you want to try a lesson with us?
Your answer
what do you hope to achieve in the lessons?
Learn to ride/skate
Learn a specific trick
Improve your riding/skating
Other:
CONTACT DETAILS
Name of Parent/Guardian (if applicable):
Your answer
Relationship to Participant (if applicable):
Your answer
Contact Telephone Number:
*
Your answer
Email Address:
*
Your answer
House Number / Name:
*
Your answer
Address Line 1:
*
Your answer
Address line 2:
Your answer
Town/City:
*
Your answer
Postcode:
*
Your answer
APPLICANT INFORMATION
Have you had coaching at Source Park before?
*
Yes
No
If yes, please state what course:
Your answer
Please give a general description of the participant's ability, if any (can pedal standing up, dropping in, standing and push along on a skateboard, etc.):
*
Your answer
Please advise if the participant has any medical or learning needs we should be aware of:
Your answer
COACHING OPTIONS
What form of coaching are you interested in? (select one or more)
*
Eagles group coaching
1-2-1 coaching
Required
If you want to book a 1-2-1 coaching session, please advise below of three dates and times you will be available for a lesson (from these dates, an available coach would be booked and you will then be contacted to make payment and confirm the session):
Your answer
How did you hear about Coaching at Source Park?
*
Your answer
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