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October 2025 - Suffolk Roller Derby - New Skater Form
Sign up for beginner roller derby training in 2025
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Email *
Personal Details
Full legal name *
Pronouns *
Date of birth *
MM
/
DD
/
YYYY
Under 18? If Yes please request an under 18 Parent/ Guardian waiver. *
Address *
Contact number *
Previous skating experience *
Rollerderby name (If applicable)
Rollerderby number (if applicable)
Health conditions *
Please state below any allergies or pre-existing medical conditions (e.g. asthma, epilepsy, diabetes), including appropriate treatment if applicable.
Emergency contact details
Name of emergency contact *
Their relationship to you *
Emergency contact number *
Further information
Which venue/s are you / will you be attending? *
Required
Advance request for SRD loan equipment
(not applicable for social scrims)
 *
Tell us the kit and sizes you need to borrow:
Helmet - Small, Medium, Large
Pads (knees, elbows, wrists) - Small, Medium, Large, XL
Skates - UK shoe size
How did you hear about us? *
Required
Declaration
By signing this form I agree that:
-I will respect and abide by the Suffolk Roller Derby (SRD) code of conduct. In particular, I agree to observe all safety instructions, not to participate while under the influence of alcohol or illegal drugs, and to show respect to all other skaters, referees and officials.
-Any photos or recordings taken of me during SRD activities may be used by SRD for publicity purposes. If I wish to opt out of photography or recording I will inform the session coach.
-My personal details can be kept on file by SRD for the purposes of administration.
-I will be responsible for the security and care of my own equipment, and any loaned to me by SRD.
-I am medically and physically able to take part in any skating activities I choose to undertake, and I consent to receiving any medical treatment deemed necessary.
-I understand that skating activities can be inherently dangerous and serious accidents can and do happen. I understand that I will be exposed to risks during skating activities, and damage to my person and my property may occur. I declare that I have voluntarily read and understood this warning and accept and assume the inherent risks in skating activities. I accept that, to the maximum extent permitted by law, Suffolk Roller Derby and its representatives do not accept liability for injury, death, or any loss or damage to my property caused during its activities.
I have read and understand the terms as given above. To the best of my knowledge, the information I have provided is true and accurate. If my details change, I understand it is my responsibility to inform an SRD committee member. *
Required
Signed: *
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