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Derby Interest Form
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* Indicates required question
Email
*
Your email
Name
Your answer
Skating/Derby Experience
Your answer
Please choose the option(s) that best describe how you would like to join our league!
New Skater
Transfer Skater (has previous derby experience)
Referee
NSO - Non Skating Official
Clear selection
What is your interest/commitment level in joining at this time?
Feeling it out. Not sure.
1
2
3
4
5
I'm ready to roll! Get me on wheels!
Clear selection
Please indicate your vaccination status in relation to COVID-19. For league members we require full vaccination (one of Johnson & Johnson or both Moderna/Pfizer)
*
Fully vaccinated
Partially vaccinated - 2nd shot still needed
Scheduled to be vaccinated
Unvaccinated
Prefer not to say
Submit
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