Registration form - Ōtautahi Rollers
Thank you for your interest in joining Ōtautahi Rollers

Please complete a new form for each person you are registering.

All our trainings are held at:
Wharenui Sports Centre
73 Elizabeth Street
Riccarton
Christchurch

Our Programmes:

Junior Learn To Skate
Friday 5.30pm to 6.30pm
First session Friday 5 March
Cost: $50 per term

Junior Learn To Derby
Friday 5.30pm to 7pm
First session Friday 5 March
Cost: $50 per term

Adult Learn to Skate & Learn To Derby
Sunday 5pm to 6.30pm
First session Sunday 7 March
Cost: $40 per month

Sk8 Skool
Friday 7pm to 8.30pm
First Session Friday 5 March
Cost: $100 for a 10 skate concession card or
$15 per casual skate

Ōtautahi Roller Derby Team training
Sunday 6.30pm to 8.30pm
First session Sunday 14 February
Cost: $40 per month

Speedskating
Training / Fun sessions
Hagley Park Netball Courts
Monday : 4pm-5pm
Wednesday : 4pm-5pm
+ indoor session TBC
Cost: $40 per month

Skaters are able to hire skates and protective gear at $5 per session.


All prospective members of Ōtautahi Rollers are required to complete a registration form. All details will be kept in a secure database with access restricted to authorised league officers only.

We will send you an invoice via email once we have received your registration.
Email *
Skater Name *
Roller Derby Name (if applicable)
Phone number *
Skater Date of Birth *
Parent/Caregiver Name (if skater is under 18)
Which Programme are you registering for? (You may select more than one) *
Required
If the skater is under 18, their parent or caregiver must be present at training for the duration of the session. *
Required
MEDICAL INFORMATION - Ōtautahi Rollers has a duty of care to all our skaters.
Emergency Contact *
Emergency Contact Phone Number *
Does the skater have a medical condition? *
If yes, please detail:
PERSONAL AGREEMENT - By submitting this form, I am agreeing that I am physically fit and capable of full participation in the selected skating programme. I agree to notify Ōtautahi Rollers of any changes to the medical information provided. In the event I am injured I give my permission for the team coach/management to obtain emergency medical treatment on my behalf. I am aware that skating represents a risk of injury and waive any legal liability of Ōtautahi Rollers for any injury resulting from either direct or indirect participation in the sport. *
CAREGIVER / PARENTAL AGREEMENT - I give permission for my child to participate in JUNIOR SKATING PROGRAMME with Ōtautahi Rollers. By submitting this form, I am agreeing that my child is physically fit and capable of full participation in the selected skating programme. I agree to notify Ōtautahi Rollers of any changes to the medical information provided. In the event my child is injured I give my permission for the team coach/management to obtain emergency medical treatment on my behalf. I am aware that skating represents a risk of injury and waive any legal liability of Ōtautahi Rollers for any injury resulting from either direct or indirect participation in the sport. As a caregiver/parent I agree to remain present in every training at visible distance. *
Required
MEDIA RELEASE AGREEMENT - Ōtautahi Rollers occasionally takes photographs or video during training sessions and events. We use these to promote our League. *
Required
Is there anything else you would like us to know?
A copy of your responses will be emailed to the address you provided.
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