Ann Arbor Derby Dimes Transfer Form
Derive By (Christine Doyle)
Mission Statement
Ann Arbor Derby Dimes (A2D2) is a skater-run non-profit roller derby league. We foster an environment of respect and camaraderie, while promoting athleticism and empowerment for ourselves and the community.
Welcome to Ann Arbor Roller Derby! We are so excited to have you. Ann Arbor Derby Dimes (A2D2) are a flat track roller derby league representing the Ann Arbor, MI area in the exciting and fast growing sport of roller derby. No experience is necessary to become an amazing roller derby player. If you have the dedication, we will make sure you get the training. One of the great things about roller derby is that, regardless of your size, shape, or skill level, there is a position for you!
League Dues
Monthly dues are $40 and are due on the 1st of every month. If dues are not paid by the 3rd of the month, you will incur a $2 late fee, and you will not be permitted to skate at practice, compete in bouts, or attend league functions until your balance is paid or arrangements are made with the Financial Director. If you are unable to pay on time, please contact the Financial Director ( or Assistant Financial Director ( prior to becoming delinquent to make arrangements. You may pay any dues collector directly by cash or online via Venmo (

Our league requires that any skaters who try out for and make a team are a member of a committee and do work that benefits that committee each month. Non-teamed members are exempt from committee work. If you do not do any committee work during a certain month, you will have 5 practice credits deducted from your attendance totals on the 1st of the following month. This may affect your scrimmage and/or bout eligibility.

WFTDA Insurance
Skaters are required to purchase insurance from WFTDA at a cost of $70 per year. Coverage is from January 1st through December 31st. After July 1st, the cost is prorated for the year to $40. Skaters are STRONGLY encouraged to have primary care insurance. Get more inform about obtaining WFTDA insurance further down in this form.
Time Commitment
Roller derby requires a fairly big time commitment. Because our league is entirely volunteer-run, skaters are also required to attend quarterly league meetings, volunteer at bouts and fundraisers, and attend meetings within their committee. But don't be discouraged! We know everyone has a life outside of derby, and A2D2 is designed with varying commitment levels to suit everyone. There are many league members who balance work, family, school, and derby. It's possible and you'll see it's well worth the time commitment. You'll get out of the experience what you put into it. And remember, if you don't have the availability to be a skater - reffing and NSOing (non-skating official) are awesome jobs that are just as important to keep the league rolling! if you are unable to attend a bout, fundraiser, or league meeting, you must contact the secretary ( one week prior to the bout, or you will garner a one week suspension from practices.
Skaters who have previously bouted with any league, or have been an active skater participant for more than 3 months with a league who are not yet bouting are eligible to transfer into A2D2. An eligible transfer skater may begin skating at A2D2 practices when she moves to town, but will be unable to skate in scrimmage at practices until she is evaluated by the training collective. Once transferred, all scrimmage and attendance eligibility apply. Transfers will need to skills test with A2D2 at the first available time. You will be notified of when the next skills test will occur. After A2D2 teams have been established, transfer skaters are eligible to try out for a league team whenever the next team assessment happens, after they have participated and made attendance for one month. In the case that there are no upcoming assessments, transfer skaters will be placed in The Bank (unteamed skaters).
Winter/Spring practices are held at:
The Mint
444 James L. Hart Parkway
Ypsilanti, MI 48197

Summer/Fall practices are held at:
Buhr Park
2751 Packard Road
Ann Arbor, MI 48104

Team practices are held on different days throughout the week, with an all-league scrimmage night on Wednesdays. Skills passed skaters are allowed to attend any team practice for attendance credit.

Monday: Bruisers practice - 7:30pm to 9:30pm
Tuesday: Vigilantes practice - 7:30pm to 9:30pm
Wednesday: All-League scrimmage night - 7:00pm to 9:30pm
Thursday: Brawlstars practice - 7:00pm to 9:00pm (scrimmage for Brawlstars only from 9:00pm to 10:00pm)

The majority of our communication is done through our forums and email. You will be notified via email about practice cancellations/changes, league votes, league meeting dates, etc. To view the A2D2 Google calendar, go to You will be required to register on our website and we expect you to login daily for updated news and information. If you don’t have internet access, please let us know.

Any time you have questions or concerns, you should contact the appropriate Board Member(s) directly.

*Note: The "A2D2 Forever" Facebook group is minimally monitored by the league and should not be considered an official form of league communication

Amelia SpareParts (Jackie Zimmerman)

Snarky Malarky (Carri Underwood)

Marty McFlyBy (Martyn Fox)

Little Awful Annie (Renee Holden) and Bigtails (Sam Brdek)

Hellinor Bruisevelt (Elinor Epperson)

Radioactive Isatope (Isa Daher)

Ruthless Bruiser Ginsburg (Ashley Curry)

The Hammer (Mari Hemmer) and Freeda Radical (Emily Bowers)

Arya Snark (Mary Lee)


Twitter: @a2derbydimes - Regular status updates
@a2derbylive - Live bout updates

Flickr: - All of our event and bout flyers can be found here






You must sign AND date all of the following items prior to participating in your first practice:
Membership Application

Policies and Procedure Acknowledgement Signature Page

Non-Compete / Non-Disclosure / Conflict of Interest Agreement

Code of Conduct Agreement

Assumption of Risk / Release From Liability Agreement

Please email a clear photo of any state-issued ID, military ID, or student ID that lists your date of birth to, before attending your first practice.
For skating members, $75 for WFTDA Insurance, which is valid from January 1st to December 31st. WFTDA insurance is prorated after July 1st to $40 for league members and $45 for non-league members.

If you are an active skater on a WFTDA member league, you should already have WFTDA insurance and will not need to pay this again for the year. If your insurance has lapsed, you will need to renew for the year before attending practice.

Please contact for instructions on how to purchase insurance or, if you already have insurance, to transfer to the league.

$40 for Monthly Dues
May be paid in cash or via Venmo (


Last Name *
Your answer
First Name *
Your answer
Full Derby Name *
Your answer
Derby Nickname *
This is the name you prefer to be called.
Your answer
What pronouns do you use? *
ex. She/Her/Hers, He/Him/His, They/Them/Theirs, etc.
Your answer
What uniform number would you like to use? (Enter N/A for refs or volunteers). *
If your number is already in use by a member of A2D2, then you will be notified to pick a new one.
Your answer
Previous League *
What is the most recent league of which you were a member?
Your answer
How long has it been since you were a member of this league? *
If you are currently a member of this league, enter 'current member'.
Your answer
What is your expected date of transfer? *
When would you like to start attending practices? If you do not have a specific date, please give your best estimate.
Your answer
DOB (Date of Birth) *
Your answer
Email Address *
Your answer
Cell Phone Number *
Your answer
Would you like to be added to our emergency SMS text alerts? If yes, please enter your cell phone PROVIDER below. If no, please skip to next question.
**DO NOT ENTER YOUR PHONE NUMBER** This will only be used for practice cancellations due to weather, or other emergencies.
Your answer
Emergency Contact #1 *
Please include name, phone number, and relationship to you of emergency contact.
Your answer
Emergency Contact #2 *
Please include name, phone number, and relationship to you of emergency contact.
Your answer
Emergency Contact #3 *
Please include name, phone number, and relationship to you of emergency contact.
Your answer
Preferred Hospital for Emergency Care *
If no preference, then please type "none"
Your answer
Do you have any allergies or medical conditions? *
If no allergies or medical conditions, then please type "none"
Your answer
Q & A
How would you describe your skating experience? *
Your answer
What are your physical strengths? *
Your answer
What are your weaknesses? *
Your answer
What sports have you participated in in the past? *
Your answer
What goals do you have for yourself concerning roller derby? *
Your answer
What are your expectations for team / league management? *
Your answer
What personal resources do you feel you bring to the league? (ie. PR experience, event planning, artistic abilities, catering, work ethic / dedication, fitness / nutrition knowledge, etc.) Be creative with your answer. We need a lot of help to grow as a league! *
Your answer
What committee(s) would you like to participate in? *
Referees and NSOs select "Training"
The Ann Arbor Derby Dimes Policies and Procedures can be viewed online at:


I have read and understand all the contents of the Ann Arbor Roller Derby Policies and Procedures. I agree to adhere to the rules laid forth and accept any consequences should I fail to comply with these rules. *
Please type your legal name and date.
Your answer
Ann Arbor Derby Dimes Non-Compete/Non-Disclosure/Conflict of Interest Agreement - A2D2(USA) Addendum A
In consideration of my participation and continued participation by Ann Arbor Derby Dimes ("A2D2"), or any affiliate or subsidiary thereof, and in further consideration of the membership fees paid, I agree as follows:

I have no contract, agreement, claim or obligation, which may be in conflict with any obligation I have taken under this Agreement.

Except as my assigned participation may require or, as A2D2 may otherwise consent in writing, I will not disclose at any time either during or subsequent to my participation, any information, knowledge or data of A2D2 organization which I may develop or receive during the course of my participation relating to financial data, writings, policies, designs, video, team playbook, business process, training, team meetings, trade secrets, know-how, plans and programs, or any other knowledge of A2D2's which is of a proprietary or confidential nature (“the Information"), and upon release of my participation with A2D2 for any reason, I agree to immediately deliver to A2D2 all physical property, plans, designs, manuals, letters, videos, notes, reports and any other materials relating to A2D2 in my possession or under my control.

In the course of my participation I will learn and hopefully will conceive A2D2 Information during A2D2 time and at A2D2 expense, which Information relates to A2D2's interests and is likely to be of benefit both to A2D2's competitors and to A2D2 even after release of my participation. I recognize a just purpose in A2D2 protecting its investment in the Information and related training and experience. I also recognize a just purpose in A2D2's affecting such protection through continued use of my knowledge and judgment and through avoiding, for limited times, competition by, through and from former teammates trained and/or given special knowledge, contracts and/or experience by A2D2 in A2D2’s line of business and with access to A2D2's Information, equipment and financial resources. Accordingly, and with full knowledge, A2D2 will rely on this Agreement in accepting me, continuing to consider me and giving me access to its Information, I agree that:

During my participation and for one year after the release of my participation for any reason, I will not either directly or indirectly divert or aid others in diverting any trade or business which A2D2 was enjoying at the time of such release or which I have solicited on A2D2’s behalf during my participation with A2D2; without the written permission of the President A2D2.
During my participation and for one year after the release of my participation I will not own, manage, control, or operate any business which is engaged in the same or similar line of business as that carried on by A2D2, including starting a new league, without the written permission of the President of A2D2.
During my participation and for one year after the release of my participation I will not either directly or indirectly entice, aid, or cooperate with other in soliciting or enticing away any team member, customer, client or supplier of A2D2, without the written permission of the President of A2D2.
During the course of my participation as a member of the Ann Arbor Derby Dimes, I will not skate for another league as a member of any team during competitive play. I will not take on sole responsibility for training or coaching an outside league or team. I will not provide regular or recurring training for the advancement of any outside league or team. Permissible actions include:
Participating in outside training opportunities
Participating in mixed scrimmages or skating as a representative of my league on an All-Star Team
Training other leagues or groups of skaters in a one to three day capacity
NSOing for any league
Acting as a referee for any league
Coaching or bench coaching for a mixed scrimmage.
Prohibited actions include:
Skating on another league’s team to fill in for a short roster
Coaching or bench coaching an outside team or league
Training an outside league or team on an ongoing basis

Without limiting the specific obligations above to honor A2D2's confidentially and trade secret information for so long as it remains protected, I specifically agree during my participation and one year thereafter, I will accept no participation where the performance of the duties and responsibilities of the new participation will call on me to use, to disclose or to base judgment on the confidential or trade secret Information of A2D2 or to utilize the goodwill of A2D2 in assisting any competitor of A2D2, without the written permission of the President of A2D2.

In the event that any word, phrase, clause, sentence or other provision of the Agreement shall be deemed to violate any applicable statute, ordinance or rule of law in any jurisdiction in which it is used, such provision shall be ineffective to the extent of such violation without invalidating any other provision of the Agreement. It is further agreed that if at any time it shall be determined that this Agreement is unreasonable as to time, scope or area by any court of competent jurisdiction, A2D2 shall be entitled to enforce this Agreement for such a period of time and within such area and scope as may be determined to be reasonable by such court.

I further agree that in the event of any breach of the Agreement by me that injuries to A2D2 are irreparable and that A2D2 shall be entitled to injunctive relief in addition to such other and further relief as may be proper. In the event of my breach of this Agreement or any part thereof, I agree to pay all cost of enforcement of such Agreement, including but not limited to, reasonable attorneys' fees.

I understand and agree that nothing contained in this Agreement, either expressly or implied, is intended to impose any obligation on A2D2 to allow my participation for any period of time and that my participation by A2D2 is terminable at any time with or without cause by me or by A2D2.

I understand that this Agreement supersedes any and all prior Non-Compete / Non-Disclosure / Conflict agreements and understandings between A2D2 and myself. No representations have been made by A2D2 concerning the terms and conditions of participation other than those representations contained in the Agreement. This Agreement may be modified only by a written document signed by both the President of A2D2 and me.

I agree that this Agreement shall be governed and interpreted under the laws of the State of Michigan.

This is a confidential document and may be reproduced only with the written permission of Ann Arbor Derby Dimes.

I have read the Non-Compete/Non-Disclosure/Conflict of Interest Agreement and agree to its contents. *
Please type your legal name and date.
Your answer
The following is a copy of the Ann Arbor Derby Dimes Code of Conduct that will need to be agreed to and submitted with all related registration forms. The Code of Conduct is for the well-being and safety of all Ann Arbor Derby Dimes participants. Please read it carefully and speak to a Board member for any questions or comments.

The participants, coaches, officials and volunteers shall be required to follow the Code of Conduct, set forth as follows:

I hereby pledge to be responsible for my words and actions while attending, coaching or participating in an Ann Arbor Derby Dimes roller derby bout, practice or league event and shall conform my behavior to the following code of conduct:

1. I will not engage or encourage any other person to engage in poor sporting behavior, such as booing and taunting, or using profane language or gestures, with any coach, player, participant, official or any other attendee.

2. I will not engage or encourage any other person to engage in any behavior which could endanger the health, safety or well-being of any coach, player, participant, official or any other attendee.

3. I will not use or encourage any other person to use drugs or alcohol while participating in a bout or practice.

4. I will treat any coach, player, participant, official or any other attendee with respect regardless of race, creed, color, national origin, sex, sexual orientation or ability.

5. I will not engage or encourage any other person to engage in verbal or physical threats or abuse aimed at any coach, player, participant, official or any other attendee.

6. I will not initiate or encourage any other person to initiate a fight or scuffle with any coach, player, participant, official or any other attendee.

7. I will not slander or encourage any other person to slander, libel or misrepresent any coach, player, participant, official of any other attendee.

8. I will abide by any decision rendered by the Ann Arbor Derby Dimes Board of Directors.

I have read the Code of Conduct and agree to its contents. *
Please type your legal name and date.
Your answer
Ann Arbor Roller Derby (A2D2) Assumption of Risk and Release From Liability Agreement
This agreement is entered into between Ann Arbor Roller Derby (A2D2) and the undersigned participant with respect to participation in A2D2 league activities. In consideration of the participation in A2D2 activities, participant agrees as follows:

1. Participant forever waives any cause of action against A2D2 and it affiliates, owners, and agents, which might arise from participation in this activity.

2. In the event a third party (or parties) is injured in any occurrence in which the undersigned participates, the undersigned shall forever indemnify, defend and hold harmless A2D2, it affiliates, its owners, agents, and employees, for ALL costs and expenses which arise from claims by such injured parties.

3. Participant authorizes any medical treatment deemed necessary in the event of any injury while participating in A2D2 activities. It is the responsibility of participant to carry full and complete insurance coverage for personal bodily injury and personal property damage to participant and any other individuals who may be injured resulting from league activities (or, in its absence, agree to pay all costs of rescue and/or medical services that may be incurred on behalf of the participant).

4. Participant understands and accepts that roller skating, in it various forms, is a hazardous sport and has many dangers and risks, which include serious bodily injury or death. Participant hereby agrees to freely and expressly assume and accept any and all risks of injury.

5. Participant represents that they are physically fit and able to safely participate in this physically demanding activity, and that they do not suffer from any injury, defect, ailment, illness or the like which could conceivably lead to injury or death from participation in this activity.

6. The participants Assumption of Risk and Release of Liability Agreement is on behalf of the league participant, and their spouse, personal representatives, assigns, heirs, next of kin, family, relatives, executors, trustees, conservators, administrators, agents and guardians.

7. Participant agrees to give up their right to a trial by court or a jury. Any dispute or claim between participant and A2D2, including those arising out of or related to this Agreement, the interpretation of this Agreement, or any damages, shall be settled by binding arbitration in accordance with the Rules of the American Arbitration Association. The arbitrator's award shall be final and binding upon the parties, and judgment upon the award may be entered by any court of competent jurisdiction. The place of arbitration shall be the country or jurisdiction where the league is located.

8. Participant agrees to provide their own required protective gear that must be worn at all times during league activities.

9. I understand, consent to and authorize, in advance, the use of my name, voice, picture or other likeness, in combination or alone, in any broadcast, telecast, print medium, advertising, promotion or other account of a league event as approved by A2D2.


Participant, member, guest or patron shall participate in roller skating and/or any A2D2 activities at their own risk. A2D2 shall not be liable for any damages for personal injuries sustained by any participant, member, guest or patron in, on or about any premises used for A2D2 league activities from any and all claims, demands, or causes of action, including, without limitations, any claim for personal injuries arising out of the use of its facilities, services, or equipment, or arising out of the negligence of A2D2, its owners, affiliates, or agents or any other person at A2D2.


A2D2 shall not be liable for the loss or theft of, or damage to, the personal property of any participant, member, guest or patron.

I acknowledge that I have read the Assumption of Risk and Release From Liability Agreement in its entirety and fully understand this release. I agree to the terms above. I am acknowledging of my own free will and volition. *
Please type your legal name and date.
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service