Ottawa Junior Roller Derby Registration Form: Fall 2018 Session
Welcome to the Ottawa Junior Roller Derby Fall 2018 session, administered by Ottawa Valley Roller Derby, the OJRD Coaching Committee, and the Coach-Guardian-Skater Association (CGSA).

OJRD is open to skaters aged 9-17 of any level of skating experience and any gender.

Email address *
Fall 2018 Session Information
The Fall Juniors session will run Saturdays 1-3PM from January 5th 2018 to June 15th 2019. From January 5th to April 27th, practices will take place at Ottawa Tech high school, 440 Albert Street. From

There will be no practice on October 6th, November 3rd, and November 17th.

The coaching team will send you more information about the program structure and curriculum before the sessions begins.

Skater Information
Skater Last Name *
Your answer
Skater First Name *
Your answer
Skater Date of Birth *
Does the skater have any medical conditions or allergies? *
Your answer
Derby Name (if applicable)
Your answer
Derby Jersey Number (if applicable)
Your answer
Guardian Information
Guardian Last Name *
Your answer
Guardian First Name *
Your answer
Guardian Phone Number *
Your answer
Guardian Alternate Contact Number (if applicable)
Your answer
Email Address *
Please provide the address where you wish to be contacted - all registration updates will be sent to this address, and you're responsible for staying on top of the alerts we send you. Double check your spelling!
Your answer
Insurance Information
Does the skater have OHIP coverage? *
Emergency Contact Information
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Emergency Contact Relationship *
Your answer
Fees for the Fall session are $150.
I understand that the skater cannot participate until payment has been received. *
Please contact OVRD's Director of Finance if you have any questions or concerns about payment, at
Payment Method
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