CJRD Skater Registration Form
Calgary Junior Roller Derby practices on Wednesdays between 6 - 7pm at the West Hillhurst Community Association located at 1940 6th Ave NW.

Our league is co-ed and is open to youth skaters aged 6 - 17. We are an inclusive space and do not discriminate based on gender, race, sexual orientation, or class.

Your skater will be required to bring their own roller skates, protective gear (knee pads, elbow pads, wrist guards), mouth guard, and helmet. If for some reason you are unable to provide these items for your child, please contact juniors@calgaryrollerderby.com and we will see if there is anything we can help with.

The cost for registration is $50/month ($250 in total for the session), or you can prepay for a 5 month session at a discount of $200/session. We also accept KidSport funding and/or JumpStart. You will be sent an invoice at the end of August for the session payment. Feel free to email us if you have any questions: juniors@calgaryrollerderby.com

**If you are applying for KidSport, you can register and apply at https://kidsport.smartsimple.ca
**If you are applying for JumpStart, you can apply here: http://jumpstart.canadiantire.ca/en.html#apply

**if applying for KidSport or JumpStart, please select Calgary Roller Derby Association as the league you are registering for

Email address
Skater's legal name
Your answer
Skater's derby name (if they have one picked)
Your answer
Skater's derby number (if they have one picked)
Your answer
Skater's Birthdate:
MM
/
DD
/
YYYY
Alberta Health Care number
Your answer
CRDi number (if your skater has one)
Your answer
What is your skater's experience level
If your skater has played derby before, please let us know what level they are at
Name of parent/guardian
Your answer
Phone number
Your answer
Address
Your answer
Emergency contact (name, number, relationship to skater)
Your answer
Please let us know if your child has any allergies that we should be aware of
Your answer
Please let us know if your child has any emotional/mental health concerns that we should know about
Your answer
Which payment structure would you prefer?
Please read the Anti Bullying agreement with your skater and "sign" your name below. Typing your name below will mean that you have gone over the agreement with your skater, and they have agreed. https://docs.google.com/document/d/13BIGZw4kFzuEfy4usY6JZEFaWIq03EUbl3X7XUWwtHg/edit?usp=sharing
Your answer
Please note that all Calgary Junior Roller Derby members are expected to submit a cheque for $100, payable to “Calgary Roller Derby Association”. Once a member has volunteered four times the cheque will not be cashed. Please indicate below if you wish to volunteer. If you need help filling these hours please contact any board member or juniors@calgaryrollerderby.com
CJRD relies on the support from parents, coaches and skaters to make the league run successfully. Parents are expected to volunteer for games and scrimmages, and they are encouraged to join the CJRD committee. Please select the roles that you would be interested in fulfilling. Also, fear not, we will teach you anything and everything you need to know.
Required
Photo release/media consent for minors. I hereby authorize any images or video footage taken of my child, in whole or in part, individually or in conjunction with other images and video footage, to be displayed on the Calgary Roller Derby Association website and other official channels, and to be used for media purposes including promotional presentations, social media and marketing campaigns. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. (Typing your name below will count as a signature)
Your answer
Medical Release Form. If, at any time, due to such circumstances as an injury or sudden illness, I, the parent/guardian of the skater I am registering, grant permission for first aid treatment to be administered by a qualified first aid responder. In the event of an emergency I grant permission for medical procedures or treatment to be obtained from the first aid responder, skater’s doctor or emergency medical services. In the case of an emergency, CJRD will strive to contact the parent/legal guardian (if not present at the event) and/or emergency contact immediately; however, the parent/legal guardian/emergency contact understands thatfirst aid, medical treatment and transportation may be done prior to contact and that all expenses incurred for treatment, including ambulance fees is their responsibility. If your skater is not to receive first aid, medical treatment or to be transported by ambulance, the skater, the parent/legal guardian must provide a letter stating otherwise; outlining the circumstances in which first aid or medical treatment can be administered. This letter must be received by the League before participation can begin. I assume all risks and hazards incidental to such participation, including transportation to and from league activities, and do hereby waive, release, indemnify and agree to hold harmless the CJRD and its agents, assigns, representatives, officers and employees from any and all claims arising out of the skater’s participation in any and all league activities. I HAVE READ AND UNDERSTAND THE PARENTAL AUTHORIZATION / MEDICAL RELEASE.I VERIFY THAT I HAVE COMPLETED THIS FORM AND THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. I FURTHER AGREE TO ABIDE BY THE RULES/GUIDELINES SET FORTH BY THE CJRD. (typing your name below will be counted as a signature)
Your answer
Please read the Skater's code of conduct (https://drive.google.com/open?id=0B9aX1bA7TfeNWFJwTUtUWkN0bVk) with your skater and sign below. (typing your name below will count as a signature)
Your answer
Please read the Parent's code of conduct (https://drive.google.com/open?id=0B9aX1bA7TfeNaFJ5X1pDVWQxMHM) and sign below. (typing your name will count as a signature)
Your answer
Thank you for registering your skater with Calgary Junior Roller Derby! We look forward to seeing you in September.
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