Monadnock Roller Derby's June 3rd Junior Black & White Scrimmage
Please fill this out before attending the junior scrimmage. For questions, email: contact@monadnockrollerderby.com
Skater's legal name (first, last)
Your answer
Skater's date of birth
MM
/
DD
/
YYYY
Derby insurance number
Your answer
Derby name and jersey number
Your answer
Current level of play:
Refer to WFTDA for level outline, or ask your coach.
Legal guardian name (first, last)
Your answer
Legal guardian phone number
Your answer
Emergency contact name (first, last)
Your answer
Emergency contact phone number
Your answer
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