OVRD's Roller Derby 101 (Winter 2020) Registration Form
About the Winter 2020 Session of OVRD's Roller Derby 101 Program:
RD101 will run on Thursday nights for 2 hours (8:15pm-10:15pm) at Hintonburg Community Centre (1064 Wellington Street West, 2nd Floor Gym) starting January 9th through to March 26th, 2020
FULL DETAILS ON THE WEBSITE:
** PLEASE NOTE: The information we are collecting here is specifically for insurance purposes -- you will ALSO need to also provide this information to WFTDi via the form linked from our website. You do not need to worry about forwarding payment to WFTDi as we will do that for you.
If you have any questions, feel free to contact us at
Full Legal Name:
Date of birth:
Health card number:
Address (including postal code):
Will you need rental skates? Tell us your shoe size and we'll hook you up!
Anything else we should know? (Health Concerns, Existing Injuries, etc.)
I am Paying By:
E-Transfer ($250) sent to Finance@OttawaValleyRollerDerby.com (Question "WHO DO WE ROLL WITH?" Answer: OVRD2019)
PayPal ($256.68) sent to Finance@OttawaValleyRollerDerby.com - please comment "RD101"
I need a more accessible option offered to me
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of Ottawa Valley Roller Derby.