Des Moines Derby Brats 2026/27 Parental Consent Form

In consideration of being allowed to participate in any way in the Des Moines Derby Brats athletic sports programs, related events and activities, the undersigned acknowledges, appreciates and agrees that: The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury remains; and I knowingly and freely assume all such risks, both known and unknown, even if arising from negligence of the releases or others and I assume full responsibility of my participation; and I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe an 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 the Des Moines Derby Brats, Skateland, the coaches, their officers, officials, agents, and/or employees, other participants, sponsoring agencies and advertisers. (“RELEASES”) WITH RESPECT TO ANY AND ALL DISABILITY, DEATH, LOSS, OR DAMAGE TO PERSON OR PROPERTY WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I HAVE READ THIS ASSUMPTION OF RISK AGREEMENT AND FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. 

All Star Members will practice at Skateland every Saturday and Sunday 8-10am.

Rising Stars (all new members will start in this group until coaches decide that it's time to move up to the All Stars) will practice  at Skateland every Sunday 9-11am.

Fees

A  $20 enrollment fee will be charged at the beginning of the season which will be added to your first monthly dues. First payment must be made before the first practice. Skaters will not be allowed out on the skating floor without a signed waiver and unpaid first month dues. If skater decides to not continue with practices later in the season, please let us know before the start of the next month so we can remove the automatic invoicing. If skater decides later in the season to join again, there will be another $20 re enrollment fee added to your account. If you choose to pay your dues with a debit or credit card, a 4% transaction fee will be added to your invoice. Please indicate below if you'd like to pay dues by ACH (no fee), CC (+4%) or cash/check. Payments must be submitted by the 10th of the month or a $10 late fee will be added to your account.

Monthly Dues: 

$75

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Child's First name *
Child's Last Name *
Date of birth (MM/DD/YYYY)
Derby Name and Number (N/A if you don't have one yet) *
Parent's Name *
Parent's email address *
Parent's phone number *
Address *
City *
State *
Zip Code *
Special medical condition, sensitivities to medication, allergies.
How would you like to submit payment for your monthly invoice?
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I hereby consent to the participation of my child. *
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Sign the parental consent form *
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