2020 K-Town Shakedown Officials Application
2020 K-Town Shakedown
Wings Event Center, Kalamazoo MI, USA
Presented by the Kalamazoo Derby Darlins
K-Town Shakedown is a WFTDA recognized 3 day tournament on 2 tracks with a mix of WFTDA sanctioned and regulation games and JRDA sanctioned games
Starts Friday April 24th - Sunday April 26th
Tournament Head Refs:
Zsa Zsa Kapow and Dur A Queer
Tournament Head Non-skating Officials:
MegNitude and Dragon Harass
A'Blazing Grace and Thunderkate
Please list the league(s) you have affiliations with in WFTDA. Please type "Independent" if applicable.
WFTDA Insurance Number (if Applicable, please put N/A if NSO'ing only)
Please link your game history here if you have one.
Skating Official Positions
Please select the positions that you wish to be considered for the level of sanctioned game play.
Crew Head Ref (CHR)
Inside Pack Ref (IPR)
Jam Ref (JR)
Outside Pack Ref (OPR)
Alt Ref (ALTR)
Non-Skating Official Positions
Please select the positions that you wish to be considered for he level of sanctioned game play.
Crew Head Non skating Official (CHNSO)
Jam Timer (JT)
Penalty Line-Up Tracker (PLT)
Scoreboard Operator (SBO)
Score Keeper (SK)
Penalty Box Manager (PBM)
Penalty Box Timer (PBT)
ALT Non-Skating Official (ALTNSO)
Please list your emergence contact and the relationship to this person.
Emergency Contacts Phone Number
Please list all allergies and medical conditions that we should be made aware of. Also if there are any dietary restrictions that you may have.
Reference #1 and Email Address
Reference #2 and Email Address
Reference #3 and Email Address (Optional)
Anything Special You Think We Should Know?
Code of Conduct and Professional Signature
I understand that as an official of K-Town Shakedown that I will be representing the event, the Kalamazoo Derby Darlins, the leagues participating in the event, and my crew. As such I will perform consistent with the Rules of Flat Track Roller Derby (including all applicable publications, Q/As, casebook entries, and standards as of 27 April 2018). Also, I understand that I will be expected to perform consistent with the WFTDA Code of Conduct and Risk Management Guidelines (a/k/a "Safety Policy"). I understand that while this is a hobby and fun should be a large factor in doing this, that I will be professional and sober (of all intoxicating substances) during all my "shift" (i.e. "until all the games I am scheduled for that day have been completed").
I understand and sign to the above in the affirmative.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service