New Recruit Registration
First Name *
Your answer
Last Name *
Your answer
Your Pronouns *
E.g. she/her, he/him, they/them
Your answer
Email *
Your answer
What city/town do you live in? *
Your answer
Can you legally certify that you are age 18 or older? *
You must be 18+ to skate with PVRD. If you are between the ages of 13-17, you may be interested in our Junior Roller Derby program instead: http://www.pioneervalleyrollerderby.com/jrderby
Do you have proof of primary health insurance? *
You must have primary health insurance to skate with PVRD.
Which session are you registering for? *
What size skate will you need to rent? *
If you have skates and any safety gear, bring them. Skates and loaner gear can be rented for $5, but we cannot guarantee all sizes will always be available depending on the turnout. You will need these pieces of equipment: quad skates, knee pads, elbow pads, wrist guards, a helmet, and mouthguard. The Bruised Boutique in Nashua, NH has excellent discount beginner roller derby gear packages available: http://www.bruisedboutique.com/
In what capacity are you looking to join PVRD? *
Please check all that apply.
Required
What is your roller skating experience level? *
How did you hear about this event? *
Please check all that apply.
Required
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