Norfolk Roller Derby Participant Waiver (2025)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please read this document carefully.

Fitness

It is my responsibility to ensure that I am medically fit to participate in strenuous on-track or off-track activities. As stated below, participation in roller derby activities presents an inherent risk of injury to person or property. I certify that I have no known conditions that prohibit or limit participation in any derby or skating activities held by or in association with members of the Norfolk Roller Derby League (NRD).

Equipment and Skates

I must wear the following mandatory safety equipment properly during all Norfolk Roller Derby League on-track activities and practices: KNEE, ELBOW and WRIST PADS and HELMET. MOUTH GUARDS are strongly recommended for all activities and are mandatory during any exercises involving physical contact with other skaters. Only quad roller skates are permitted. All skates must be track-safe, meaning that their use must not gash, indent or blemish the skating surface or any other surface and that the skates will not cause injury to property or person(s). I should use the appropriate wheel composition available to achieve the best possible grip on the skating surface. I am liable for any loss or damage caused by failure to adhere to these requirements.

Conduct

I must behave in a respectful manner to both person and property; at all times I will abide by the NRD Code of Conduct (available on Trackkarma).

Photo Waiver

NRD activities and events may be recorded and/or photographed; by participating in such activities I accept I will be recorded/photographed. I understand it is my responsibility to notify the Marketing team if appearing in public NRD posts is an issue (as of 29/12/24, member preferences are collected in the 'NRD Policies' section of TK).

Data Protection

NRD may retain the details I provide for a period of time, consistent with its Data Protection Policy.

Indemnification and Risk Acknowledgement

In consideration of being allowed to participate in any way in NRD sanctioned athletic sports programmes, related events and activities including, but not limited to; practice sessions, team meetings, public appearances, fundraising activities or travel to and from the aforementioned sanctioned activities, I state and certify the following:

1. The risk of injuries from the activities involved in this programme is significant, including the potential for permanent paralysis and death. While particular rules, equipment and personal fitness may reduce this risk, the risk of serious injury remains.

2. I understand that it is my responsibility to seek medical advice around my physical health and safety to play this sport. NRD will not ask to see any medical records. However, if I have a condition that means I am at an increased risk of injury, I must seek advice from a medical doctor; my signature on this waiver confirms that a doctor has agreed that it is safe for me to play a contact sport with risks similar to rugby or ice hockey.

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS any NRD member, league, the venues, coaches, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors and advertisers (“RELEASEES”) WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property (other than death or personal injury arising from the negligence of the Releasee concerned).

Waiver agreement: *

I HAVE READ THIS PARTICIPANT WAIVER AND ACKNOWLEDGEMENT AND I ACCEPT RESPONSIBILITY; I FULLY UNDERSTAND ITS TERMS AND I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO IT, WHICH I DO FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

My (legal) name is: *

Are there any medical conditions that NRD/first aiders should be aware of? (Asthma, hearing impairment, allergies, etc)

Emergency Contact Name *

Emergency Contact Phone Number *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Norfolk Roller Derby.

Does this form look suspicious? Report

Forms