Junior Derby Summer Camp Registration Form
Emerald City Junior Gems present Junior Derby Summer Camp for new or modified junior derby skaters.
Saturday August 20th 9:00am-3:30pm
Willamalane Center for Sports and Recreation
250 S. 32nd St. Springfield

Registration Deadline: August 15, 2016

Scholarship Deadline: August 1, 2016

Please make sure to complete all 4 pages of this form

Camper's legal name *
Your answer
Camper's skate name, if you have one
Your answer
How did you hear about the Junior Gem's Camp?
Birth date *
Mailing Address *
Your answer
Email Address *
Email is our primary form of communication, including billing and information about the day. Please note if you do not have access to email regularly.
Your answer
Phone number *
Your answer
What is your level of skating experience? *
Are you a returning Gems skater? *
If you have played junior derby, how long have you been actively skating? (Months/years)
Your answer
Do you have your own skates? *
If you don't have your own skates, what size shoe do you wear? (Please specify adult or youth size)
Your answer
Do you have protective gear? (Check all that apply) *
All skaters are required to bring a mouth guard already formed to fit.
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