SJRDL Registration Form - September to December 2022
To be filled out prior to first practice

If you have any questions please email
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Email *
Player Derby Name (if nothing yet please type na) *
Player Derby Number (if nothing yet please type na) *
CRDi/WFTDi Insurance Number (if nothing yet please type na) *
Player SK Health # *
Player Date of Birth *
Street Address *
City/Province *
Postal Code *
Skater Email (If applicable)
Skater Cell phone (If applicable)
Parent/Guardian Name *
Parent/Guardian Cell Phone *
Parent/Guardian Email *
2nd Parent/Guardian Name (If applicable)
2nd Parent/Guardian Cell Phone (If applicable)
2nd Parent/Guardian Email (If applicable)
Emergency Contact Name *
Emergency Contact Phone Number *
How are you planning to pay for this session? Fees are $150 for this session (ie monthly payments, one time payment before first practice, etc) *
Are you thinking of opting into fundraising for this session? *
How did you first hear about us? *
Any other info needed for the coaches to best help/support your skater (ie. medical, mental, physical) (type na if nothing) *
Fees and Insurance
Fees will be payable by cash, cheque, or e-transfer. Each skater is also required to purchase insurance from prior to the first practice. Annual membership is recommended, however, new skaters may choose to purchase the quarterly apprentice membership, which will last 3 months.
I, parent/guardian of this SJRDL skater, hereby give authorization for participation in any and all Saskatoon Junior Roller Derby League activities. I hereby grant permission to managing personnel and league representatives to authorize and obtain medical care for any licensed physician, hospital or medical clinic, should the skater become ill or injured while participating in league activities when neither parent nor legal guardian is present to grant authorization for immediate treatment. I assume all risks and hazards incidental to such participation, including transportation to and from league activities, and do hereby waive, release, indemnify and agree to hold harmless the Saskatoon Junior Roller Derby League, SCRDA and its agents, representatives, officers, volunteers and employees from any and all claims arising out of the skater’s participation in any and all league activities. I have read and understand the above registration form and parental authorization/medical release. I verify that I have completed this form and that the information provided is true and correct. I further agree to abide by the rules/guidelines set forth by the Saskatoon Junior Roller Derby and CRDi.  Signed with my name digitally. *
I hereby authorize any images or video footage taken of my youth (under 18 years of age), in whole or in part, individually or in conjunction with other images and video footage, to be used to promote the sport of Roller Derby, to be used for media purposes including promotional presentations and marketing campaigns. I also authorize the display and use of any media material created by my youth within her / his time with Saskatoon Junior Roller Derby Association. I waive rights to privacy and compensation, which I may have in connection with such use of my youth’s name and likeness, including rights to be written copy that may be created in connection with video production, editing and promotion therewith. I am over 19 years of age and the parent or legal guardian of the youth, and I have read this waiver and am familiar with its content. Signed with my name digitally. *
PARENT CODE OF CONDUCT.  By signing below I hereby agree that: 1. I will not force my child to participate in the Saskatoon Junior Roller Derby League 2. I will remember that children participate to have fun and that the game is for skaters, not the adults involved. 3. I will inform the coach of any physical disability, pregnancy or ailment that may affect the safety of my skater or the safety of others. 4. I will learn and abide by the rules and the policies of the league. 5. I (and my guests) will be a positive role model for my child, as well as, their teammates and encourage sportsmanship by showing respect and courtesy, by demonstrating positive support for all players, coaches, officials and spectators at every game, practice or scrimmage. 6. I (and my guests) will not engage in any kind of unsportsmanlike conduct with any official, coach, skater or parents such as booing and taunting; refusing to shake hands; or using profane language or gestures. 7. I will not encourage any behaviours or practice that would endanger the health and well being of the skaters. 8. I will encourage my child to play by the rules and to resolve conflict without resorting to hostility or violence. 9. I will encourage my child to treat other players, coaches, officials and spectators with respect regardless of race, creed, colour, sexuality, gender or ability. 10. I will encourage my athlete and other players to put their best effort forward regardless of the outcome of the game or their performance. 11. I will promote the emotional and physical well being of the skaters ahead of any personal desire I may have for my child to win. 12. I will respect the officials and coaches during games or practices. I recognize this time is valuable and needs to be used effectively. 13. I will approach the coaches privately if I have any questions or concerns so we may work out a solution together. I, as a parent in support of my athlete, will follow this code of conduct and understand there may be consequences if I don’t.  Signed with my name digitally. *
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