Santa Cruz Derby Groms - Groms Squad Registration
The Groms Squad is the amazing group of volunteers, officials, and coaches that help run Santa Cruz Derby Groms day to day operations, practices, scrimmages, games, and events.

-Volunteer Dues are $20 per year
-Official Dues are $50 per year (Ref and NSO)
-Coach Dues are $50 per year

Contact us if you have any questions regarding registration: groms@santacruzderbygroms.com
Given Name *
Your answer
Derby Name *
Your answer
Cell Phone Number *
xxx-xxx-xxxx format
Your answer
Home Phone Number
xxx-xxx-xxxx format
Your answer
Email Address *
Your answer
Home Address *
Your answer
Emergency Contact Person Name *
Your answer
Emergency Contact Person Cell Phone Number *
xxx-xxx-xxxx format
Your answer
What role are you registering for? *
Required
What size unisex t-shirt do you wear? *
Please type your name below indicating that you acknowledge the JRDA Code of Conduct: *
Please review the JRDA Code of Conduct linked below. By signing below, you acknowledge, understand, accept, and agree to comply with the JRDA Code of Conduct. Link to JRDA Code of Conduct here: https://drive.google.com/a/santacruzderbygroms.com/file/d/1e1Y-W6dzWTA0mY3c2UtudFm_RmLaC4Dq/view?usp=sharing
Your answer
Please type your name below indicating that you understand your financial commitment to the Santa Cruz Derby Groms: *
By signing below you are indicating that you understand that there are financial commitments associated with Santa Cruz Derby Groms membership. Groms Squad dues are $20 per year for volunteers, $50 per year for officials, and $50 per year for coaches.
Your answer
What happens next?
1. After submission of this form, SCDG will review the registration information.

2. An invoice for dues will be generated and sent to you by email.

3. SCDG will contact you with further information.
Submit
Never submit passwords through Google Forms.
This form was created inside of Santa Cruz Derby Groms. Report Abuse