Niagara Roller Girls New Skater Registration
Caught the roller derby bug? Join now! Once you've read our Frequently Asked Questions and have obtained roller derby insurance from CRDi, fill out this form and click submit!
Name
Address
Derby Insurance #
Email address:
Phone #
Cell #
T-Shirt Size
Clear selection
Date of Birth
MM
/
DD
/
YYYY
Ontario Health Card #
Do you have any health issues we should be aware of?
Medications?
Previous Injuries?
Emergency Contact Person and reltaionship
Emergency Contact #
Emergency Contact Address
Submit
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