Learn to skate & play Roller Derby - Expression of Interest form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hi, this is our expression of Intrest form for our free come try days and/or term classes for "Learn to skate & play roller derby"

FREE COME & TRY ROLLER DERBY

Sunday 14.4.24 - 2.45-4.15pm @ Eltham Leisure Centre!

No equipment or experience needed!

We have skates and protective gear we can loan you for the day at no cost.

This free come and try day is a great way to see if you want to join our ‘Learn to Skate & Play Roller Derby’ course with no obligation.

Fill in this registration form to sign up for the come and try day. After the come and try day, you can decide if you want to do the term classes :)

————

TERM COURSES

These classes are for people who want to learn to skate and learn to play roller derby. All genders, ages (15 & above), fitness & skating abilities welcomed and catered for! We can teach you to skate & play even if you have never had skates on your feet before, people are encouraged to progress at thier own pace.

TRAINING TIMES & LOCATIONS

Sunday: 2.45-4.15pm
Basketball courts at Eltham Leisure Centre, 40 Brougham Street Eltham.
(Park in the car park & walk through reception & the basketball courts are on the right hand side.)

Tuesday: 7.00-8.00pm
Basketball Stadium at Viewbank College, 1 Warren Street, Viewbank
(Park on the road, and follow the signs to the stadium)

The course costs $150 for the term & you will need mandatory derby insurance of $95 which lasts for the rest of the year. No need to register or pay till after the come & try day to see if it is something you might enjoy.

Your class ticket ($150) is paid by bank transfering to our club (details below):
Bank: Bendigo Bank
Name: Diamond Valley Roller Derby Club
BSB: 633000
Acc: 151179074

Insurance is paid directly to our insurer Skate Australia by following this link :
https://www.revolutionise.com.au/sa/registration & selecting Roller Derby Development Membership.

Quad skates, helmet, wrist guards, knee guards and elbow guards are required but we have gear available to loan FREE for the term. You will need to purchase your own mouth guard if you do the term course 🙂

Email *

Skaters Full Legal Name *

Skaters Preferred Name *

Skaters Pronouns (eg they/them, she/her, he/him) *

Skaters Phone Number *

Skaters Date of Birth (Must be 15 years or older) *

YYYY

Skaters Next of Kin Name & Phone number in case of emergency *

Do you need to Borrow Skates? (Please tell us your shoe size) *

Do you need to borrow Protective Gear? (Please tell us your clothing size) *

Tell us about your skating experience.

(We have diverse skill levels in our classes and welcome people who have never skated to competent skaters)

Is there anything you would like us to know about your health and how we may be able to support you? (eg knee problems, diabetes, asthma, anxiety, autism etc)? *

How did you hear about us? *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Diamond Valley Roller Derby Club. Report Abuse

Forms