Roller Skating Private Lesson Request Form
Submit your information below to request a lesson from Steph at Salazar Training.

In this form you will select which time slot you prefer and length of lesson as well as location.

The information given below will be reviewed and you will be contacted by Steph to arrange a lesson time and date within your preferred time slot chosen.
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Email *
Participant Name *
Parent name (If applicable)
Parent Phone (If applicable)
Phone Number *
Emergency Contact *
Emergency Phone *
Skill level *
Skating history *
Other sports training previously or currently? *
Weekday(s) of lesson preferred (check all that apply) *
Required
Time slot preferred (check all that apply) *
Required
Location you would like to visit. (List all possible options) *
Any helpful notes for Coach Steph. (Goals, allergy info etc) *
I understand that there is a 24hr minimum notice for cancellation of scheduled lessons *
Required
I understand that I will have to pay $$ upon arrival *
Required
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