Thank you for your interest in joining the Charlottesville Derby Dames at our Summer 2023 New Member Open EnROLLment! This form must be completed in its entirety in order for you to join us at the Albemarle High School auxiliary gymnasium in Charlottesville, VA on July 23 at 10:00am (use entrance B3 near the tennis courts). The information collected on this form is for administrative purposes only. We will not sell or give your information to anyone else.

This Open Enrollment will run for 6 weeks from July 23 - August 27 on Sundays from 10:00am-12:00pm with bonus off-skates sessions to build foundational strength and learn more about the sport and our league on Thursdays 8/3, 8/17, and 8/31 from 7:00-9:00pm. We will have skates and safety gear available to use for the Sunday skating sessions or you are welcome to bring your own gear/skates if you have them! (If you are interested in playing roller derby, you must wear quad roller skates. If you are interested in officiating roller derby on-skates, you may choose to wear quad skates or inline skates.) If you are interested in opportunities to get involved off-skates, please email getinvolved@charlottesvillederbydames.com.

The cost is $60 for participation in the 6-week session. We prefer cards for payment (easier to track) but can also accept cash or checks. If you need to request a partial or full fee waiver, please complete this request form  after completing this registration.

If able, please consider printing, signing, and bringing the waiver linked in the form below. We will have copies of the waiver at AHS in case you can't print.

**Although personal insurance isn't required for participation, injuries can happen and we highly recommend that anyone getting on skates has personal health insurance.