QuadSkate Beginner Class Registration Form @PLSC Subang Jaya
Class only for 16 years old and Above
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Email
*
example@example.com
Mobile Phone Number
*
-
Area Code
Phone Number
I'm down with (Inclusive of Utilisation of Skate Rink and Bring your own pair of socks)
*
1 Hour session - Rental Skates Class : RM 80
Combo1 Hour x 3 sessions - Rental Skates Class : RM 216
Private Class 1 on 1- Rental Skates : RM100
Combo1 Hour x 3 sessions Private Class- Rental Skates : RM270
GROUP 1 Hour session- Rental Skates Min pax of 5 :RM 350
Book Your Slots!
*
Book Your Slots! Private Class
*
Book Your Slots! Combo! Class 1 Private Class
*
Book Your Slots! Combo! Class 2 Private Class
*
Book Your Slots! Combo! Class 3 Private Class
*
Book Your Slots! Combo! Class 1
*
Book Your Slots! Combo! Class 2
*
Book Your Slots! Combo! Class 3
*
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Medical Information
Does the skater have allergies including asthma?
*
Please explain on the field provided, For GROUP , Please specify each members accordingly
Is the skater currently under medication?
*
Please provide the details, the name of the medication and period of intake and for Group please specify each member
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Contact Information in Case of Emergency
For Group Booking- 1 Representative info is suffice
Name
*
First Name
Last Name
Contact Number
*
-
Area Code
Phone Number
Relation to skater
*
Payment
Payment to Maybank Account 562106881662 -AENEYONWHEELS ENTERPRISE or QR Pay as below image
Total amount for Class
*
Proof of Payments
*
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