2021 RDC Online Membership Form
Welcome to Roller Derby Canada Services (RDC). RDC provides information and membership that incorporates insurance for all forms of derby – flat track, banked track, women’s, men’s, co-ed and junior derby across Canada. The cost of RDC membership is $55 and includes coverage for 12 months from the date you request membership to start.

Apprenticeship memberships are $30 and are available for a new junior or senior skater who is trying out the sport or taking a new skater program. This membership is for 4 months only and if you are still skating once this has expired, you can sign up for a full membership at $55 for one year. Apprentice skaters are not covered to skate in games.

Dedicated skating officials have a special membership cost of $30 per year. This option is not for officials who also play roller derby.

If you have any questions, please contact us at pamtera@rdcservices.org

Once this membership form and payment have been received RDC will email you a membership number to the email provided on this form, you will be covered once you receive your membership number. Please double check that your email is correct, and watch your spam/junk box for your confirmation email.

All RDC memberships are non-refundable and non-transferable.

To obtain membership please follow these instructions;

Please fill out this form once, please do NOT duplicate
Please press SUBMIT at the end of this form.
You should immediately see this response from the form: "RDC membership form received, your response has been recorded."
Once filled out, send etransfer payment to PAMTERA@RDCSERVICES.ORG
$55 Yearly Membership, $30 Dedicated Skating Official, or $30 Apprentice Membership (4 months)
PLEASE include your real name and your league you belong to in the email transfer MESSAGE box available to you when completing the email transfer.

You will receive confirmation via email within 24- 48 hours, if you do not receive email confirmation, check your junk/spam box and then contact us at Pamtera@RDCservices.org

Have fun on the track!

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Province you live in *
First Name *
Legal name - no nicknames - must match your DL or passport - you are responsible for spelling your name correct here. PLEASE use applicable capital letters at start of your name.
Last Name *
Legal name - no nicknames - must match your DL or passport - you are responsible for spelling your name correct here. PLEASE use applicable capital letters at start of your name.
Derby Name
If you do not have one skip this question
Address *
City *
Postal Code *
Date Born *
Month Born *
Year Born *
League Name *
Please double check your league name with your trainer, recruiter or board member as we can not accept team names. If you do not see your league below there is an option to add it at the end of the list.
Health Care Number *
It is mandatory that you provide us with your health care number (this info is needed for the accident insurance part of your membership)- if you can not find it you must submit it to your league within 30 days. Your membership card will not be issued until we have this info.
Province of Provincial Health Care number *
Please mark what Province your health care card was issued
Email Address
Once this membership form and payment have been received RDC will email you a membership number to the email provided on this form. Please double check that your email is correct, errors will delay processing your membership.
Membership Type *
Once this membership form and payment have been received RDC will email you a membership number to the email provided on this form. Please double check that your email is correct, errors will delay processing your membership.
What date do you need your membership to start? *
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Please read the below statement and print YOUR FULL REAL NAME/Parent name for youth in space given below. *
Waiver/Release: In consideration of being allowed to participate in any way in the sport of Roller Derby related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risk of injury from the activities in this program is significant, including the potential for permanent paralysis and death, and the risk of serious injury does exist, and- I knowingly and freely assume all such risks both known and unknown even if arising from the negligence of the releasees or others and assume full responsibility for my participation and, - I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, - I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Roller Derby Canada Services, their officers, officials, agents and/or employees, members, member leagues, coaches, volunteers, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event ("Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I understand that all RDC memberships are non-refundable and non-transferable. I acknowledge that I am over the age of 18 years old or that I am the parent/legal guardian of the above said player and that I have read this document and by printing my name in the box below I am signing this document
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