Ottawa Junior Roller Derby Registration Form: Fall 2017 Session
Welcome to the Ottawa Junior Roller Derby Fall 2017 session, administered by the Capital City Derby Dolls and the OJRD Coaching Committee.
Fall 2017 Session Information
The Fall Juniors Session runs from September 16, 2017 to December 16, 2017.

There is no practice on September 23, October 7, November 4, and November 18.

From September 16 to October 28, practice will be held from 10:30am -12:30pm.
From November 11 onward, practice will be held from 1:00-3:00pm.

Practices will be run at the gymnasium of the Ottawa Technical High School:
- 440 Albert Street, Ottawa, ON, K1R 5B5
- entrance off of Slater Street (between Bronson Avenue and Bay Street)
- parking is available underneath the building or in the lot to the side
- the gymnasium is on the second floor

The coaching team will send you more information about the program structure and curriculum.

Skater Information
Skater Last Name *
Your answer
Skater First Name *
Your answer
Skater Date of Birth *
Does the skater have any medical conditions or allergies? *
Your answer
Derby Name (if applicable)
Your answer
Derby Jersey Number (if applicable)
Your answer
Guardian Information
Guardian Last Name *
Your answer
Guardian First Name *
Your answer
Guardian Phone Number *
Your answer
Guardian Alternate Contact Number (if applicable)
Your answer
Email Address *
Please provide the address where you wish to be contacted - all registration updates will be sent to this address, and you're responsible for staying on top of the alerts we send you. Double check your spelling!
Your answer
Insurance Information
Does the skater have OHIP coverage? *
I understand that I will be required to purchase (or show proof of) CRDi insurance in order for the skater to participate. *
2017 CRDi Insurance Number (if applicable)
Your answer
Payment for the Fall Session is $140. It covers the practice period from September 16 to December 16.
I understand that the skater cannot participate until payment has been received. *
Please contact CCDD's Treasurer if you have any questions or concerns about payment, at
Payment Method
Note: if the skater does not already have CRDi insurance, that purchase is separate - please scroll down on the following page to the payment information under "East Pro-rated Membership $30 plus 1.25 fee for July-Dec 2017" to pay for CRDi for the remainder of 2017 (you must REGISTER - link above - AND follow the instructions to pay in order to get coverage):
Emergency Contact Information
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Emergency Contact Relationship *
Your answer
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