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Reserve
An Adventure!
The following information will provide information needed
to reserve space on your upcoming skate adventure! Please
fully complete the form. Also, please do not hesitate to call
or email us with any questions or concerns. A $300 down deposit
is due when booking. The remaining fee is payable no later
than 45 days in advance of program start date. Please pay
by check or money order. If you want to rent our quality inline skates (Minnesota Adventure only), please indicate shoe
size. The skate rental fee is $25/ day. Please remit payment
to: Robichon's® Skate Vacations, PO 11121, Minneapolis,
MN 55411. For detailed policies, click here on terms
and conditions.
Reservation
Form
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Last Name __________________ First Name ______________ Date
of Birth ___/___/______ M/F
Last Name __________________ First Name ______________ Date
of Birth ___/___/______ M/F
Last Name __________________ First Name ______________ Date
of Birth ___/___/______ M/F
Complete Street Address________________________________ Apt.
#____________________
City/Province ______________________________ State _______
Country ________ Zip Code ______________
Telephone Number (____) _____-_______ Work Number (____)
_____-________
E-Mail Address: __________________________________________
Program Title __________________________ Program Location
____________________________
Program Date ____/_____/______ - ____/_____/______
Single Room Supplement Request? Minnesota
Adventure ($75 extra per night): Yes or No
Florida Adventure ($100 extra per night):
Yes or No
Skate Rental? (Minnesota Learn to Skate Adventure only) List
Skate Size (s); 1_____ 2 ______ 3. ________
Fee Enclosed $____________________ Check # ___________ Money
Order #___________________ PayPAL_____________
Important and Helpful Information:
What is your current inline skill level? ___Beg. ___Adv.
Beg. ___ Inter. ___Adv. ____ Expert
Have you had inline instruction ? If so where and with who?
______________________________________
What is your goal when participating in Robichon's® Skate
Adventure? ______________________________________
Would you like us to send a brochure to your friends, health
organization, social club, children's center, place of work?
(if so, please list names and addresses)
Do you own a pair of inline skates? ___Y ___N What Kind?
___________
What is your occupation? ________________________
How did you hear about Robichon's? ___ Internet? What Site?
_________ Flyer ______ Periodical ____ Newspaper _____ Other
Please list ___________________________
Do you have any health concerns for which we should be aware?
____ Please Explain? _____________________________________________________________________________
Emergency Contact Name? __________________________ Emergency
Contact's Phone Number ( ) _____-__________
Do you have any special dietary needs? Y ____ N ___ Please
Explain: ____________________________________________________________________________________________
Declaration: By submitting this form, I accept the terms
of Robichon's® as laid out on this reservation form and
the reservation conditions, including the payment and transfer
paragraphs. I realize I will be sent and must sign a release
of liability form before departing on a skate adventure. I
also realize full protective equipment including good-fitting
helmets, wrist guards, elbow and knee pads are mandatory.
I understand participants under 18 years of age must be accompanied
by an adult and a legal guardian or parent must sign for participants
under 18.
Please Print Full Name: _________________________________________________
Signature:_______________________________________________________
Robichon's® Skate Vacation's™
PO BOX 11121, Minneapolis, MN 55411, 612.82.SKATE (75283)
info@robichons.com
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