The Beehive Skate Revolution Summer Session | September 13 - December 6, 2018 |
SKATER INFO
Skater Name *
(If unknown, type "none".)
Your answer
Skater number *
(If unknown, type "none".)
Your answer
Email address *
Your answer
Phone number *
(Please use 801-123-4567 format)
Your answer
Legal name *
Your answer
Emergency contact *
Your answer
Emergency contact phone *
(Please use 801-123-4567 format)
Your answer
Medical conditions *
(Past injuries, allergies, med alert, etc. If none, type "none.")
Your answer
INSURANCE
WFTDA insurance must be purchased to skate at the Derby Depot. The cost is $80 per year, and can be purchased online at https://wftda.org
Do you have valid WFTDA insurance for 2018? *
CHOOSE YOUR COURSE
BSR:
$80/12 weeks, Thursday night. All levels.

BSR & The Bee Team:
$100/12 weeks, Thursday night, Sunday evening. Intermediate and advanced skaters. Option to travel for games against other b-level teams..

BSR & Wasatch Roller Derby Full:
$65/month, M-W-Th-S. Intermediate and advanced skaters.

The Bee Team:
$60/12 weeks, Sunday evening. Intermediate and advanced skaters. Option to travel for games against other b-level teams.

To streamline check-in, pay session dues now through PayPal and select "prepaid." (Please select "Send money to friends or family" to avoid fees.) If you prefer to pay at check-in, select "unpaid."

Payment: *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms