Jingle & Roll Registration

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Fill out this form if you plan to attend CCRD's Jingle & Roll on December 15, 2021.

Requirements:
- Ages 18+ only.
- Must have personal medical insurance.
- Must wear the following safety gear: helmet, hard-shell wrist guards, elbow and knee pads. Mouth guards are optional.
- Must wear a properly-fitting face mask (covering nose and mouth).
- Some skating experience is required. You should feel comfortable skating in a roller rink and know how to stop safely.
- Must agree that you are not experiencing any signs of illness and that you have no known exposure to illness over the past 10 days.

Cost:
$15 per person. Pre-pay by PayPal. See https://www.capecodrollerderby.com/jingle-roll-2021 and use the "Buy Now" button.

First and last name *

Derby name (if you have or had one)

Email address where you can be reached *

Are you currently a member of a roller derby league? *

Yes

If yes, which league? If no, what league were you formerly associated with? If you've never been part of any league, leave blank.

Do you agree to all of the requirements listed above? *

Yes

Any songs you want us to add to the playlist?

Submit

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