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Medic Interest Form for EASTBOUND THROWDOWN - A WFTDA Continental Cup
Please fill out this form if you are interested in volunteering as medical staff for EASTBOUND THROWDOWN, the 2019 WFTDA Continental Cup for North America East. This event, hosted by the Dutchland Derby Rollers, will be held at Spooky Nook Sports on August 23-25, 2019.

Spooky Nook Sports
75 Champ Blvd, Manheim, PA 17545

All medical staff must meet one of the following medical licensure or certification requirements:

- Certified First Responder (CFR), Emergency Medical Technician (EMT), or Paramedic
- Physician with sports medicine, orthopedic, and/or emergency medical experience
- Athletic trainer or physical therapist with CPR training
- Licensed Practical or Registered Nurse with current CPR training and sports medicine, orthopedic, and/or emergency experience.
- Nurse Practitioner or Physician's Assistant with current CPR and sports medicine, orthopedic, and/or emergency experience.

These requirements are outlined in Section 4.1 of the WFTDA Risk Management Guidelines below. Please familiarize yourself with this document. The Dutchland Derby Rollers will also provide an Emergency Action Plan, which all volunteers will be required to review and follow.

All volunteers will receive a free ticket for the day they are scheduled to work. Volunteers will be given a Medical Staff t-shirt to be worn during their shift. Please refer to the certification section of this application for additional dress code information.

Applications are due July 8.

The tournament Safety Officer will contact all applicants by email the week of July 15 to provide more information on selection, assignments and scheduling. Thank you for your interest in our event!

Tournament Facebook event is here:

You can follow the Dutchland Derby Rollers by visiting our website ( or on Facebook (

Learn more about the WFTDA Continental Cups program at

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