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 *
Derby Name *
Cell Phone Number *
xxx-xxx-xxxx format
Home Phone Number
xxx-xxx-xxxx format
Email Address *
Home Address *
Emergency Contact Person Name *
Emergency Contact Person Cell Phone Number *
xxx-xxx-xxxx format
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
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.
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.
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