Non-Voting Skater Membership Form - Mad Rollin’ Dolls, Inc

Summer Camp participants, Mad Wreckin Dolls, Transitional/transfer members, and Other Membership Form (Revised 10/16)

    CONTACT INFO

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    MEDICAL PROFILE

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    Event Participation Following Injury or Other Medical Conditions/Reactions

    I understand that if I am involved in a medical situation, via injury or other conditions, in which MRD Trained Safety Personnel feel it is unsafe for myself or others if I was to continue participation in MRD event activities (including non-skating and skating events), that MRD Trained Safety Personnel are authorized (but not required) to request cessation of my participation in those events.
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    Medical Profile Access Authorization

    I authorize Mad Rollin' Dolls, LLC to store and access the above health information as needed. I understand this information will be maintained in digital form as a Google spreadsheet and in paper form stored with rink first aid supplies held within a secured folder, so that in case of injury, my information can be readily available. **Mad Rollin' Dolls will allow access only as necessary by authorized league members in the event of injury or illness.** I understand that Mad Rollin Dolls is not an organization that must follow the federal privacy standards, (covered organizations include health care providers, health plans, and health care clearinghouses). Therefore, the health information disclosed above as a result of this authorization, may no longer be protected by the federal privacy standards and my health information may be disclosed without obtaining my authorization.
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    MRD NON-VOTING MEMBER RESPONSIBILITIES

    As a Non-Voting Member of the Mad Rollin' Dolls, I will: Adhere to the Code of Conduct and the League Policy on Nondisclosure of Confidential Information Abide by the policies of the league and work within the league hierarchy Abide by the policies and procedures established in the operations codes for any committees of which I am part Fulfill attendance requirements and give appropriate notice for any absences Pass a test, as applicable, before performing in my position Give notice before leaving the league Notify the league of any changes in contact information (mailing address, email, phone, etc.) for the purposes of receiving league notifications Participate in COC/Promo/Bout Day credits as applicable Pay dues Obtain insurance through WFTDA if my position requires it Login to my WFTDA account and electronically sign the WFTDA Non-Disclosure Agreement if position requires it
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    MRD NON-VOTING MEMBER RIGHTS

    As a Non-Voting Member of the Mad Rollin' Dolls, I have the right to: Attend all-league meetings and any open committee meetings* Be appropriately trained to perform any work I do for the league Join and participate in committees and attend practices* Leave MRD at any time Participate in Yahoo! Groups and discussions* Access the MRD Yahoo! Group* Apply for a Staff or Skater position *conditions may apply and include requirements to maintain a WFTDA profile and electronic signature of the current WFTDA NDA

    MRD NON-VOTING MEMBER VOTING RIGHTS

    As a Non-Voting Member of the Mad Rollin' Dolls, I am eligible to vote: On any decisions made within a committee of which I am an active member

    MEMBERSHIP AGREEMENT

    By signing below, I verify that my application information is complete and correct. I agree to fulfill the responsibilities of my position and membership level, abide by the policies of the league and work within the league hierarchy, and to follow the operations codes and policies of any committees of which I am a part. I understand that such policies, operations codes and policies are subject to change at any time, and that remaining informed of current policies, operations codes and policies is my responsibility. I have received, read, understand, and agree to the League Code of Conduct and the league policy on the Nondisclosure of Confidential Information. I understand that if my application information is found to be incorrect, or if I fail to meet requirements of my position and membership level, I am subject to management review, league determined consequences and possible membership termination.
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