2026 Academy Registration & Waiver Form

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We're excited you're interested in joining Greensboro Roller Derby (GSORD)! We'll update this form to let you know about our next academy date!

If you have any questions, please contact me (Bull Terror) at membership@greensbororollerderby.com

Name (First & Last) *

Pronouns *

Skater Type *

Skater

Referee

Other:

Required

Date of Birth *

YYYY

Email *

Cell Phone *

Street Address *

City, State, Zip *

Emergency Contact Name *

Emergency Contact Cell Phone *

Any conditions or injuries we should know about?

General Waiver *

I agree to release Greensboro Roller Derby or its successors, and/or its owners, officers, directors, coaches, volunteers, employees, or agents from any and all liability and/or claims in respect to loss or damage arising from personal injury to myself and/or my children, or from loss or damages to personal property.

Furthermore, by signing this agreement any such claims, rights and/or causes of actions against Greensboro Roller Derby or its successors, and/or its owners, officers, directors, coaches, volunteers, employees, or agents are hereby waived.

I also agree that I will be held liable for any damage caused to league property and I will indemnify the league and the practice location from any injuries that might occur while my children/family participate in league functions in or outside of any hosting venue.

I agree to the General Waiver as stated above

Practice Code of Conduct *

1) Always bring a positive mental attitude!

2) Be respectful to the individual(s) running practice, your teammates, the officials, and yourself through practicing kindness and using inclusive language.

3) Be timely to practice-geared up and ready to go as quick as possible

4) Inform trainers/captains of absences, tardiness, and physical/emotional wellness.

5) Know yourself-grab water when you need it, pull yourself if it’s not feeling good, communicate any significant issues that could impact practice

6) Bring and wear all of your gear all of the time -- that includes BOTH a black and white shirt!

7) Avoid wearing and/or spraying perfume or disinfectant at practice (people have allergies).

8) Regularly clean and check gear, skates, mouth guards

I agree to the Practice Code of Conduct as stated above

Photo Waiver *

I hereby grant permission to Greensboro Roller Derby to use photographs and/or video taken at the practice or any League event in publications, on the internet, in brochures, or any other advertisements or promotional materials related to the mission of Greensboro Roller Derby.

I agree to the Photo Waiver as stated above

Other:

Do you need to borrow gear for Academy? (Helmet, knee, elbow, and wrist guards and skates are required, mouth guard optional) **We have a limited supply of loaner gear and cannot guarantee we have safety gear in your size** *

Yes

What size street shoe do you wear if you need to borrow skates? Skates are our most limited inventory at this time and are loaned out based on what we have available.

Describe your skater experience *

Brand New to Skating

Some Skating Experience

Pretty Good at Skating

I can skate and have played derby before

How did you hear about us? *

Google Search

Community Event like Pride or Fun Forth

GSORD Event

Word of Mouth

Other:

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