Participant Name

Parent/Guardian Name

Additional client if semi-private

Contact phone number

Contact e-mail address

Age

Instructor preference (name or male/female)

Is the participant continuing? Yes No

Desired times and days
(Lessons will be set up more quickly if you have multiple times that would work for you.)


Location preference (you may check more than one)
East Boulder Community Center
North Boulder Recreation Center
South Boulder Recreation Center

Level Desired (you may check more than one)
A B Master

How Many Lessons? 1 3 6

Lesson Duration: 30 minutes 1 hour


Experience or level if known:


Special needs: