Derby Fest 2019 Juniors Mixer Registration
Thank you for registering for a regulation junior mixer at NJRD's Derby Fest on November 30. Please complete the following form to register for the event and provide contact information. The cost of registration is $20 per game, which includes a t-shirt and entry to the event.

Juniors may only register for ONE mixer (either Level 2 or Level 3), and Level 3 skaters may NOT register for the Level 2 mixer. To be considered for the level 3 mixer, juniors MUST have passed their Level 3 skills test.

Juniors Level 2 mixer will be 11:30am-1:30pm [cats vs. dogs]
Juniors Level 3 mixer will be 3:30pm-5:30pm [Hawkins vs. The Upside Down]

If you have any questions, please send an email to newjerseyrollerderby@gmail.com.
Email address *
Child's name (first and last name): *
Your answer
When is your/your child's birthday? *
Your answer
League affiliation: *
Your answer
Skater name: *
Your answer
Skater number: *
Your answer
Which level do you/does your child play?
How many years have you/your child been playing roller derby at that level? *
Your answer
What is your/your child's shirt size? *
Parent name: *
Your answer
Parent phone number: *
Your answer
Juniors Mixer Themes
You may only register for ONE mixer game, either level 2 or level 3. If you've passed level 3 minimum skills, please do NOT register for the level 2 mixer. NJRD may not be able to accommodate all team requests (we'll try our best).
Level 2 Mixer [11:30am-1:30pm]
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LEVEL 3 MIXER REGISTRATION IS CLOSED
A copy of your responses will be emailed to the address you provided.
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