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