MARD Mixed Open Scrimmage

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What is your legal name? *

How will you be participating? *

Skater

Skating Official

Non Skating Official (NSO)

Other:

What is your email Address? *

What is your Derby name?

What is your Derby number?

What is your WFTDA/USARS insurance policy number (for skaters and skating officials)? *

What league are you a member of? *

How long have you been BACK (after the COVID shutdown) practicing with your league? MARD is dedicated to providing everyone involved with the SAFEST open scrimmage possible please provide us any details we might need to assess your safety in advance i.e. you are new to skating or just returning or have been practicing for months etc.

What is your skill level (for skaters only)?

Beginner (1-2 seasons bouting)

Intermediate (2-3 seasons bouting)

Advanced (3+ seasons bouting)

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Please select your position preference?

I generally jam

I generally block

I generally jam and block

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Are you vaccinated against COVID? In an effort to keep everyone as safe as possible, at this time we are only allowing vaccinated participants or participants with medical exemptions to participate in our scrimmages. You will be asked of proof upon entry to the event.

Yes

Yes, and I have my booster

No, I have a medical exemption

Other:

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Additional Comments? (i.e. preferred ref position or first time scrimmaging with an outside league etc?)

Submit

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