Junior Roller Derby Intake
High Tide Derby has a new junior roller derby team in Garden Grove, CA. Have a child interested in this sport that wants to improve their skating skills, team work, and build confidence in themselves? We want to build the perfect program for them to excel.

If you have more than one child interested, please fill out the form for each child.
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Email *
Parent's Name *
Parent's pronouns
Parent's Email *
Parent's Phone number *
Child's Name *
Child's pronouns
Child's birth date *
MM
/
DD
/
YYYY
City of Residence *
Child's Skill Level *
All skill levels are welcome! Our trainers will meet all skaters where they are at and help them grow. 
Required
Does your child have skates and protective gear? *
Roller Skates (quads), knee pads, elbow pads, wrist guards, helmet
How did you hear about the Junior Team at High Tide Derby? *
Parent, are you interested in being involved in our Adult roller derby league? As a skater or a ref.
Clear selection
Parent, are you interested in being involved in our Junior roller derby league? As a trainer or a ref.
Clear selection
We look forward to coaching your child(ren) in the amazing sport of roller derby! 
If you have any questions, email us at hightidederbyjuniors@gmail.com.
A copy of your responses will be emailed to the address you provided.
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