VRDL Learn to Skate Registration Form
Please complete this form to register for our VRDL Learn to Skate program.
We will send you a follow-up email confirming your place in the our program.

Our Skate programs 3x per year. Learn to Skate is a 10 week program covering all the basic non-contact skills needed to progress onto intermediate level roller derby. Sessions run Mondays 6:30-8:00, in Preston.

Cost: $175 per term + $80 per year (insurance fee)
Gear required: roller skates, helmet, wrist, elbow and knee pads.
Email address *
Skater Information
Full Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Skating Experience *
Do you have Skate Victoria Insurance? *
Please note SV needs to renewed at the start of each calendar year.
Other Information
Do you have private health insurance?
If yes, please name provider. If no, leave blank.
Your answer
Do you have ambulance cover? *
Required
Do you take any medication that may affect your skating ability or affect medical treatment, should you be injured?
If yes, please provide details. If no, leave blank.
Your answer
Do your have any allergies that emergency staff should be aware of?
If yes, please provide details. If no, leave blank.
Your answer
Emergency Contact Person *
Your answer
Relationship *
Your answer
Emergency Contact Number *
Your answer
Declaration
Please note: VRDL cannot offer full or partial refunds to skaters who are unable to, or decide not to complete the Learn to Skate program once payment has been made. By checking the boxes below, you are stating that you agree to the terms of this statement as well as the following policies and procedures:

Code of Conduct: https://docs.google.com/document/d/1vn4lvUMs1vBkgCYrwNtp4LSO_YhrnQ0SojuTosHK5vY/edit?usp=sharing

Waiver and Public Release: https://docs.google.com/document/d/1nQ2MJAnx9jMXwjn6oLqR6maeb2hn1m2XET3fgQ_b0Zk/edit?usp=sharing
Please tick boxes *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service