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Kitchener LOCO New/Visiting Skater Form
Thanks for your interest in Kitchener LOCO roller derby.
Before your first night skating with us, please fill out this form.
What to bring?
1) comfortable athletic wear 2) a molded mouthguard 3) water 4) face mask 5) Insurance or the waiver below
If you are brand new to derby, please also fill out this waiver and bring a copy with you:
https://static.wftda.com/insurance/wftda-insurance-membership-waiver.pdf
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Telephone number
Your answer
New skaters only: Which best describes you?
Never roller skated / ice skated / roller bladed
Have some skating experience (ice or wheels)
Confident skater (ice or wheels)
Have previous roller derby experience
Other:
Clear selection
Visiting skaters only: Which best describes you?
Have never bouted / not min passed
Retired skater
Currently bouting with another league
Other:
Clear selection
Visiting skaters only: What is your insurance (WFTDI or other) number?
Insurance is required for visiting skaters.
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone
*
Your answer
A copy of your responses will be emailed to the address you provided.
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