Register for the NCJD Fall 2021 Session
The Fall 2021 Session will run Aug 16 - Dec 15 with 2-hour practices at LSF (7600 N 70th St) on Mon & Wed 6pm - 8pm. *No practice Mon Sept 6 and Wed Nov 24*

Registration Cost (non-refundable):
New and Established Skaters: $200 if payment received in full on or before Aug 18, 2021.
Established Skaters Only: $105/mo. for 2 months for a total of $210 (due Aug 18, Sep 15 & Oct 13)
(established skaters are those who have completed at least two sessions within the last calendar year)

VERY IMPORTANT - Payment Methods:
DO NOT PAY NO COAST ROLLER DERBY - That is the ADULT league. You must pay No Coast JUNIOR Derby!!!

**Add Skater Name in note/on memo for all payments**

1. Venmo: @nocoastjuniorderby
2. PayPal: paypal.me/nocoastjuniorderby
3. (Established Skaters Only) Check - payable to: No Coast Junior Derby (hand delivered by skater)

A late fee of $20 will need to be added to registration total if received after the due date(s).

**Limited Scholarships Available - email nocoastjuniorderby@gmail.com for more information**

Insurance:
Accidental Skater Insurance is included in the registration cost.

Waivers & Forms:
All skaters, returning and new, must complete new waivers and form annually in August. All Parent/Guardian in the #1 field below will receive a DocuSign invitation to read, review and sign the necessary waivers and forms. These forms must be completed prior to your skater being able to skate with us. Please sit with your skater to do so as they must agree and adhere to all policies within.

Add the NCJD Google Calendar to your device: https://calendar.google.com/calendar/u/2?cid=bm9jb2FzdGp1bmlvcmRlcmJ5QGdtYWlsLmNvbQ

New Skaters/Parents/Guardians: Join NCJD Parents Facebook Page: https://www.facebook.com/groups/ncjdparents

REQUIRED PARENTS MEETING:
Monday, Aug 16, 2021 | 6pm-6:30pm | Lincoln Sports Foundation

Questions: email nocoastjuniorderby@gmail.com

Note: The Fall 2021 Session will be a FULL CONTACT session (no COVID-19 restrictions). However, based on JRDA Return-to-Play guidelines, local COVID-19 cases, LPS and DHHS Health Directives we reserve the right to change to this to NO or LIMITED contact at anytime during the session.
Choose Payment Option Below *
Skater's Derby Name - CONFIRM SPELLING WITH SKATER BEFORE SUBMITTING (Please enter skater's legal name if a Derby Name has not yet been chosen) *
Skater # - CONFIRM NUMBER WITH SKATER BEFORE SUBMITTING. *Depending on skater number availability, we may reach out for an alternate number* *
What are your skater's pronouns? Check all that apply - CONFIRM WITH YOUR SKATER BEFORE SUBMITTING *
Required
If applicable, select what gear you need to borrow. NCJD will reach out to gather details shortly.
Skater's Legal Name (FIRST & LAST) *
Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Home City, State and Zip *
School *
Grade *
Skater's Email Address? (Skater will receive emails from NCJD Coaches via Google Groups)(Leave blank if not applicable)
Parent/Guardian #1 First and Last Name (main contact) *
Parent/Guardian #1 Phone (include area code) *
Parent/Guardian #1 Email (will be used to send league communications from NCJD Coaches via Google Groups) *
Parent/Guardian #2 or Emergency Contact First and Last Name *
Parent/Guardian #2 or Emergency Contact Phone (include area code) *
Parent/Guardian #2 Email (if email is entered, it will be used in addition to Parent/Guardian #1 Email to send league communications from NCJD Coaches via Google Groups)
Primary Insurance Carrier and Policy Number *
Preferred Hospital/Clinic/DR
Does your skater have any known allergies or medical problems? If NO, enter NO below. If YES, please explain. Please include all known food and drug allergies, mental health concerns, physical ailments and anything that we need to be aware of or that may impact your skaters ability to fully participate at times. *
Will your skater be driving themselves to/from practice this session? *
How'd you hear about us?
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Previous League Affiliation (for transfer skaters only; not required for past or present NCJD skaters)
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