I want to play Roller Derby!
Yeah baby! Are you interested to come and play the greatest sport on the planet?! Well of course you are. We will help you 'roll with it', we will just need some basic information and then you are ready to come and practice with us!

Please fill in the form below. Then we will welcome you on our practices:
Sunday 13/10 16.00h @Rode Loop 2
Sunday 20/10 16.00h @Rode Loop 2
Sunday 27/10 16.00h @Rode Loop 2
Email address *
Last name *
Your answer
First name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Phone number *
Your answer
Do you have your own 'quad skates'? *
Shoe size? *
Your answer
Do you have your own protection? *
Who should we contact in case of an emergency? (Name + Number) *
Your answer
Which Sunday will you be able to attend? *
Required
Any Remarks?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service