Register for the NCJD Spring 2021 Session
The Spring 2021 Session will be LIMITED CONTACT (no face-to-face drills).

Session will run March 22 - April 28 with practices at LSF (7600 N 70th St) on Mon & Wed 6pm - 7pm.

Registration Cost (non-refundable): $125

Payment Methods:
1. VenMo (preferred method): pay to: nocoastrollerderby@gmail.com or NoCoast RollerDerby
2. PayPal: pay to: nocoastrollerderby@gmail.com - Choose "Friends and Family" for PayPal payments.
3. Check - payable to: No Coast Junior Derby (hand delivered by skater)

**Add note on all payments: <Skater(s) Name> NCJD Spring 2021**

Notice: A late fee of $20 will need to be added to registration total if received after the 2nd day of practice.

Insurance:
Accidental Skater Insurance is included in the TD and Furies registration cost.

Waivers & Forms:
NCJD documents have been amended to include the safety guidelines and expectations put in place as a result of COVID-19. If you did NOT skate with NCJD in the Fall 2020 or Winter 2021 sessions, parents will be required to complete new NCJD, OJRD and JRDA forms prior to starting the Spring 2021 session. Once your registration is received, we will send an email to have the NCJD, OJRD and JRDA forms reviewed and signed electronically through DocuSign.

Forms are NOT required for those returning from the Fall 2020 or Winter 2021 session.

Questions: email nocoastjuniorderby@gmail.com
Skater's Legal Name (FIRST & LAST) *
Date of Birth *
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School *
Grade *
Street Address *
City, State and Zip *
Derby Name - PLEASE CONFIRM SPELLING WITH SKATER BEFORE SUBMITTING *
Skater # - PLEASE CONFIRM NUMBER WITH SKATER BEFORE SUBMITTING *
Skater Email? (Skater will receive emails from NCJD Coaches via Google Groups)
Do you need to borrow equipment?
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Previous League Affiliation (not required for past or present NCJD skaters)
Parent/Guardian #1 Name (main contact) *
Parent/Guardian #1 Phone *
Parent/Guardian #1 Email (will be used to send league communications from NCJD Coaches via Google Groups) *
Parent/Guardian #2 or Emergency Contact Name *
Parent/Guardian #2 or Emergency Contact Phone *
Parent/Guardian #2 Email (if email is entered, it will be used in addition to Parent/Guardian #1 Email to send league communications from NCJD Coaches via Google Groups)
Primary Insurance Carrier/ Policy Number *
Preferred Hospital/Clinic/DR
Does your skater have any known allergies/ medical problems? If NO, enter NO below. If YES, please explain. *
How'd you hear about us?
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