2023 March Madness Scrimmage Skater Registration (Double Header)
If you plan on skating, please fill out the following form. 
Date: March 11, 2023 

Location: Great Brook School, 16 School St, Antrim NH 03440 

Time: Doors open at 12:30, first whistle is 1:30pm (Juniors L1&L2) 3:30 (Juniors L3)
JRDA rules Level 1, 2, and 3 all gender
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Email *
Government name:
Preferred name (if different):
Pronouns:
Derby Name:
Derby Number:
My roller derby experience:
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Do you have insurance with your league for roller derby? Please check one. (If you skate with a league, you are probably covered. Ask your coach!)
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Derby insurance: insurance # is:
Juniors are most likely covered under their Junior league. Check with your league if you are unsure.
The league I skate with is:
Parent name:
Parent Email (if different)
Parent cell number:
List an emergency contact with name and phone number (different than above):
Any pertinent info we need to be aware of? Allergies, medical conditions, etc.
Do you have friends and family who would like to officiate? Add name and contact info or share this link. Here is the link to the Google Form: https://forms.gle/My2hvy2bsot1SmreA
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