QCJRG Junior Roller Derby Info Request
Thanks for your interest in Junior Roller Derby!

Please fill out the form below to provide us with your contact information, and some brief skater details. We'll be using this information to provide you with details and updates.

Here's a list of resources to check out online:

Junior Roller Derby Association - http://www.juniorrollerderby.org/
JRDA Rules - http://juniorrollerderby.org/resources/JRDA_Rules3_1.pdf
Parent/Guardian's First Name *
Parent/Guardian's Last Name *
Email *
Phone Number
Skater's First Name
Skater's Last Name
Skater's Age
Skater's Proposed Derby Name
Please describe any skating / skating sports experience.
Please detail any affiliation you have with QCRG or QCJRG.
Please describe any special needs or considerations.
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