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Namekagon River Roller Lesson Registration 2024
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PARTICIPANT First and last name
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Participant birthdate.
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Age as of January 1, 2024 (your age on Jan 1 2024 determines placement for the year)
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Years rolling experience
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Primary Parent Name First and Last
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Primary Parent Address
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Primary Parent phone
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Secondary Parent Name
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Secondary parent email, if necessaary
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Emergency Contact name
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Emergency Contact phone
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Does your son/daughter have any allergies we should be aware of
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Does NRR have permission to seek medical treatment for your child if they are injured/ill and a parent or guardian is not available?
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Select age group and lesson dates
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U5 Select Choice for Lesson Time
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U7 Select Choice for Lesson Time
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U10 Select Choice for Lesson Time
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U13 Select Choice for Lesson Time
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U16 Select Lesson Time
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Second choice of lesson.
Indicate and list if there is another day and time you would consider for lesson times if the first choice is full
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By submitting this form you agree to the 2024 Liability Waiver and Media Waiver for NRR
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Indicate any conflicts such as: Are you attending Summer School, or is another family you wish to be scheduled with?
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By submitting this form, you agree to the Media Waiver and Acknowledgement of Risk Waiver
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