Roller Derby 101
Complete this form to register for PARD Derby 101 course.
Registration fee of $150 can be paid by cheque or cash (in person) or by e-transfer to Please make the answer to the security question the word "rollerderby."
Email address *
First name *
Last name *
Date of Birth *
email address *
phone number *
Address *
name of emergency contact person *
emergency contact phone number *
Have you played roller derby before? *
If yes, where?
How did you hear about our Derby 101 course? *
Do you want an appointment to try on gear with Rumbling Rage Skate shop on December 7th? *
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