Register | SK8HERS INC

Let's Get Ready to ROLL!

Program Elgibility:

SK8HERS INC is a female-focused youth development and roller-skating program designed specifically to serve girls between the ages of 8-18.

I confirm that my child meets the eligibility requirements for participation in the SK8HERS INC girls' program.

Student First Name:

Student Last Name:

Student Date of Birth: (Must be at least 8 years of age)

Month

Day

Year

Student Address:

School/Homeschool:

Student ID #:

Grade Level:

Student Shoe Size (Please specify if it's a youth size or women size):

In order to participate in SK8HERS Inc. non-traditional programming, your student must own a pair of quad roller skates. Does your child have a pair?

YES

NO

Student SK8HERS INC Membership status:

New Member

Current (Previous School Year)

Past (over 1 year ago)

What is your daughters roller skate level?

Level 0 - I can’t skate at all

Level 1.- I can skate a little but I still need help

Level 2- I can skate on my own without any help

Level 3- I can skate on my own forward, skate backwards a little, turn around backwards a little

Super Skater- I can skate forwards, turn around backwards and skate backwards on my own

(1) Parent Name:

(1) Parent Phone Number:

(1) Parent Home Address:

(1) Parent Email Address:

(2) Parent Name:

(2) Parent Phone Number:

(2) Parent Email Address:

(2) Parent Home Address:

Students' Emergency Contact Name:

Students' Emergency Contact Phone Number:

Medical and Medication Information

Does your child have any medical condition that could affect her ability to safely participate in independent roller skating or physical activity?

Does your child currently have health insurance? (a child does not have to be insured to participate)

Yes

No

Health Insurance Company:

Insurance Policy/Member ID:

Policy Holder Name and the Relationship to the Participant:

Policy Holder Phone:

List students' past and current health conditions and/or allergens:

List students' past and current prescribed medications (if any):

Please list students' past and current physical restrictions (if any):

Students' Primary Physician:

Students' Primary Physicians Address:

Students' Primary Physicians Phone Number:

Students' Last Physical Exam Date:

Do you consent to signing a liability and assumption of risk agreement, informed consent and acknowledgement form, medical authorization release form and a media release form?

Yes

No

Please upload signed waiver here:

By checking this box, I certify that I am the parent or legal guardian of the participant and that the information provided in this registration form is complete and accurate to the best of my knowledge.

Call Today 904-416-9479

2026-2027 School Year Registration Form

Please sign and the upload waiver to Registration Form below

Let's Get Ready to ROLL!

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