MAZ Coaching – Registration Form

At Mangawhai Activity Zone, Saturday 20th April, 2013, start 9:30am.

Student Name

Student Age

Guardians Name

Address

Phone Number

Mobile Number

E Mail

Emergency Contact Name

Emergency Contact Numbers

Medical Conditions

How are your skills? (select all that apply to you)
beginnerolliekick flipdropin

How long have you been skateboarding for?

How did you find out about this?

What kind of skateboard do you have?

Go back to the coaching page to get your terms and conditions / liability waiver form.