Private Lesson – Learn to Skate – Roller Skate Victoria Dance Academy

Welcome to your new obsession.

Thank you for your interest in signing up for a private learn to skate session. Please fill out the form below so that we can learn more about you and match you to the best possible instructor for your needs and goals. Once we have received your form we will be in touch shortly to organize the private lesson based on instructor availability.

Happy skating, and welcome to the skate fam!

Name *

First

Last

Email *

Confirm Email

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Emergency Contact Info

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Student Info

Student's Name

First

Last

Is the student under the age of 18? *

What are the student's preferred pronoun(s)?

Are rental skates required?

Rentals are provided free of charge for paid lessons.

If yes, what size. Please specify Men's Women's or Kids sizing.

Lesson Details

To help us pair you with an instructor please provide the following information:

Preferred day(s) of week for lesson(s): *

Preferred time of day for lesson(s): *

Pick a desired 2 hour time block for your lesson. You can choose more than one time block. We will make every effort to schedule your lesson in your chosen time block(s), based on instructor availability.

Indicate your preferred geographical location(s) for your lesson, or choose no preference. *

How long would you like the lesson to be? (30 minutes minimum) *

Please choose the roller skating level/experience that best describes the student's current skill level.

Other skating experience, please describe (optional)

Indicate your desired area of discipline you'd like your lesson to focus on

What other roller skating skills do you want to work on with your instructor?

Any additional information you feel your instructor should know prior to your lesson?

Is this lesson for one skater or a group of skaters?

Would you like to set up a recurring lesson?

Name

Waiver of Liability

All participants of a Roller Skate Victoria lesson or event are required to sign a waiver of liability in order to be able to take part. Please sign our e-waiver here, or ask about obtaining a paper copy to sign.