Intro to Roller Derby with TCRD
To register for the 6 week training session, please complete this form. Payment of $120 is due by September 12, sent by Interac e-transfer to with your name + Intro to Derby as the message.
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6 Week Training Session
Derby Name (if you don't have one, put N/A) *
Derby Number (if you don't have one, put N/A) *
Please only enter the WFTDA approved format that would be on your arm during games. No symbols or letters.
"Real" Name
Please provide us with the full name that you use in your daily life. If for any reason this is different than your legal name that is on your ID and would be required for insurance and medical emergencies please also provide us with your legal name. We will maintain privacy of this legal name and only those in positions where it is absolutely required will have access. If you have concerns about this you can leave the "legal name" field blank and contact
Full Name *
Legal Name
Personal Pronoun *
What is your skating/roller derby background (Rolla Skate Club, other derby league, etc.)? *
Please provide your WFTDi insurance number. If you don't yet have WFTDi insurance you can get it here: and indicate 'in process' below *
Do you consent to receiving periodic email communications from the league (opt-out option will always be available) *
Birthdate *
Email Address *
Phone Number *
Street Address *
Do you have medical information that should be known to first aid should you be injured at practice or a league event?
Please provide an emergency contact. Include their name, contact phone number and their relationship to you *
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