Rideau Valley Roller Girls - Registration Form
Welcome to the Rideau Valley Roller Girls! Please fill out the form below to get rolling.
Human Name *
Your answer
Skater Name
(if you have one)
Your answer
Skater Number
(if you have one)
Your answer
Street Address *
Your answer
City *
Your answer
Province *
Your answer
Postal code *
Your answer
Email Address: *
Your answer
Home phone: (If you have one)
Your answer
Mobile phone:
Your answer
Health card number:
Your answer
Birth date:
Day / Month / Year (24 / December /1982)
Your answer
Emergency Contact Name/ Relationship / Phone Number:
Louise Smith / Mother / 613-555-5555
Your answer
Current Roller derby insurance provider
(for transfers only, not new skaters)
Your answer
Roller derby insurance number
(for transfers only, not new skaters)
Your answer
Prior team/league affiliation
(for transfers only, not new skaters)
Your answer
Transfers: How long have you been bouting?
This answer does not include time spent in a Fresh Meat training program. Only those with a minimum of 1 year of bouting experience will be considered for the tryout.
Transfers: Have you spent some time off skates in the last six months?
How's your health?
Do you have any allergies or health conditions we should know about, for your own safety:
Your answer
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