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
Camper's skate name, if you have one
How did you hear about the Junior Gem's Camp?
Through a current juniors/adult skater
Through Willamalane Center
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.
What is your level of skating experience?
I have never been on skates
I have been on skates before, I can move but not turn side to side
I can skate, but haven't played roller derby
I have done some modified junior derby
I have played full contact and have bouting experience
Are you a returning Gems skater?
Yes, modified contact
Yes, full contact
If you have played junior derby, how long have you been actively skating? (Months/years)
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)
Do you have protective gear? (Check all that apply)
All skaters are required to bring a mouth guard already formed to fit.
Helmet (can be a bike or skating helmet)
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