Registered Before?:      YesNo
How many attending?:    1 2 3 4 5 6 7 8 9 10

Complete Name(,s):       
Valid Email Address(,s):  

Years of Experience:       0 1+ 3+ 5+
Program Level:              Please Select Level D (Beginner) Level C (Beginner/Intermediate) Level B (Intermediate/Advanced) Level A (Advanced)
Preferred Location:         Please Select South/West Toronto-High Park Area South/West Toronto-Oakville Area South/East Toronto-Beaches Area North/East Toronto-Markham Area North/East Hamilton-Lakefront Area North/West Muskoka-Huntsville Area
Preferred Time:              Please Select 6:00am - 7:30am 7:30am - 9:00am 9:00am - 10:30am 10:30am - 12:00pm 12:00pm - 1:30pm 1:30pm - 3:00pm 3:00pm - 4:30pm 4:30pm - 6:00pm 6:00pm - 7:30pm 7:30pm - 9:00pm
Preferred Day:                Please Select Monday Tuesday Wednesday Thursday Friday Saturday Sunday
How did you find us?:      Please Select Search Engine - Msn Search Engine - Google Search Engine - Other Internet Link Instructor Friend/Associate Direct Postal Mail Direct Email Direct Fax Trade Show Newspaper Television Radio Other
Referred By (optional):   

Special Requests:                           

There are a limited number of openings, therefore participants are encouraged to register as soon as possible. Please note that our online registration and payment system automatically closes once all openings are filled. Your completed application form and payment confirmation is guaranteed and valid up to one year from the date received.

To guarantee instant verification and processing of your registration information, we offer a completely secure and convenient online payment option through our parent company ProLaunch Corporation following this form. You may also enter and confirm payment for the Quantity of additional participants joining you if applicable. An automatic receipt for your payment and your detailed information package will be sent via email within 48 hours once your payment confirmation has been received and processed.

Please Read Before Signing:

Release: Acknowledging that inline skating is a physical sport, I agree that PROBLADER™, its agents, servants and employees shall not be liable to me (my dependent) for any injury or damage however caused resulting directly or indirectly for my (dependent's) participating in a PROBLADER™ program whether incurred on the pavement or otherwise in or about the park(s), complex(s) and/or arena(s) at any time, and I hereby discharge PROBLADER™, it agents, servants and employees from all actions, claims and damages for such injury and damage.  In the event I and/or my dependent is injured or during the absence of parent(s) or legal guardian, I give my permission for the instructor in charge to seek medical attention. I also acknowledge and agree that PROBLADER™ reserves the sole and exclusive right to use any text, video, audio, and/or photographs taken during the instructional program(s) for marketing and/or training purposes without cost or charge to PROBLADER™. I  further hereby  acknowledge and agree and understand that PROBLADER™ is fully entitled to all outstanding registration fees once I receive program confirmation and I do not reschedule my training program within 48 hours prior to program commencement.

I Agree to Information and Release:

Signature (18+) (Type Name):  Date (d/m/y):