Request edit access
BombsQUAD Registration
Co-Ed junior roller derby team; ages 6-17 years

Learn-to-Skate/ Dust-off-the-Skates 10 week Program: $150 new skaters; $50 returning skaters; Thursday October 10th @530-7 pm at Max Turyk Gym
Full Program: $300; begins Thursday January 9th @530-7 pm at Max Turyk Gym

About BombsQUAD -

For more information contact Heather Cullen at
Sign in to Google to save your progress. Learn more
Legal Name of Participant *
Name of Parent/ Legal Guardian *
Contact Phone Number *
Email *
Which programs will you be attending? check all that apply *
There is a $50 deposit required for each program upon registration to cover the skater insurance required to participate when the program starts. The balance of the program fee will be due the first day of the program. All payments can be made by cheque (made out to Fernie Junior Roller Derby League) or via PayPal to
Participants Date of Birth *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy